Director, Professional Billing Follow Up-(3308961) - Partners Healthcare System

The Opportunity

Responsible for the efficient, effective oversight of Professional Billing and Follow Up, Credits. Monitors overall accounts receivable, clean claims, denial resolution and payment trends to report on performance and implement best practice solutions. In partnership with key stakeholders, the Director, Professional Billing operationalizes the strategic direction for PFS (Patient Financial Services) and continuously works to improve people, process, and technology approaches across the functions.

Leadership Impact & Problem Solving

• Implement the strategic direction for Professional Billing and Follow Up and Credits teams, and collaborate with direct reports, functional leaders, and on/offshore resources to drive alignment.
• Communicate relevant changes in performance, market trends, health care delivery systems, and legislative initiatives impacting execution of team goals to team(s).
• Identify operational impacts of and oversee adoption of rapidly changing technology and regulatory aspects of health care and health care billing to ensure compliant operations.
• Collaborate with peer leadership and the Enterprise Revenue Cycle leaders to implement strategic plans and attainKPIs for the Revenue Cycle Organization.
• Embody Mass General Brigham’s Essentials of Leadership and develop existing talent by implementing Everybody Solves Problems and a positive organizational culture.

Operational Performance

• Develops and implements efficient and effective operational policies, processes, and best practices.
• Manages day-to-day operations of Professional Billing and Follow Up, Credits, including identification and monitoring of team success metrics and activities related to PFS functions.
• Identifies, analyzes, and follows up on payer issues, denial trends, interacting with MGB entities and practices, payer representatives and others to ensure accurate and timely billing, appeals and claims processing.
• Oversees continual improvement efforts to maximize revenue capture while ensuring compliance with all regulatory requirements.

Qualifications

• Bachelor's degree preferred with Discipline in Healthcare Administration, Management, Finance, Business Administration, or related field
• Minimum 3-5 years progressive hospital Patient Accounts, or hospital finance or related Revenue Cycle Operations.
• Minimum 3-5 years managerial experience of large and highly complex work teams
• Minimum 3-5 years broad experience with interaction and dealing with people across all levels of staff and management.
• Minimum 3-5 years previous experience with using EPIC revenue cycle application and an understanding of their approach.

Skills for Success

• Teamwork|Experienced leader that can effectively build and support diverse teams to achieve common goals and implement best practices. Must be an engaged and approachable leader who understands the value of being a team player who manages effectively across differences and can coach and develop staff.
• Collaboration and Communication|Ability to build partnerships and work collaboratively with both finance and non-finance constituents across the organization. Excellent interpersonal skills to deliver multi-mode communications, often related to complex topics, while conveying a clear understanding of the unique needs of different audiences.
• Innovation and Inclusion|Cultivate a culture of innovation and Inclusion by encouraging others to share opinions and ideas, while creating new and better ways for financial processes and operations. A demonstrated ability to manage change, while maintaining high employee satisfaction.
• Diversity, Equity, & Inclusion|Drives DE&I and recognizes the value that different perspectives and cultures bring to an organization.
• Excellent personnel management and organizational management skills – including written and oral communication, relationship management, customer service, and organization.
• Revenue Cycle operations experience in a large health system, including an in-depth knowledge of governmental and private payor payment methodologies (e.g., payer contracts, reimbursement strategies, and appeal timelines, federal and State regulations, Medicare / Medicaid rules, third party regulations,ICD and HCPCS / CPT Coding and Physician Billing).
• Lead by example to motivate teams to reach KPIs, best serving Mass General Brigham’s mission and patients.
• Ability to drive professional growth of team members in knowledge and skills through education, goal setting and personal development.
• Ability to proactively prevent problems while working with frequent interruptions and negotiating appropriately to unexpected situations and effectively resolving conflict.
• Manage change with proven success in leading executives, physicians, managers, and staff to achieve positive outcomes.

Direct Reports

• Approximately 8; may indirectly provide leadership and guidance to less seasoned andnew staff.

Fiscal Responsibility

• Monitors and drives financial planning provided by leadership to support cost-effective PFS teams.
• Oversees management of PB clean claim rate submission to support best practice performance and reduce unbilled Accounts Receivable days.
• Oversees performance of effective PB claim follow-up to support timely and complete expected payment from payers.
• Approves and is responsible for management ofHB and PB centralized credits processes to support timely and accurate reconciliation of Accounts Receivable and associated refund processing.
• Collaborate with appropriate finance and billing team members on financial analyses, practices/billing office assessments and the development ofROI and business plans.

Mass General Brigham is an Equal Opportunity Employer. By embracing diverse skills, perspectives, and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under the law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, perform essential job functions, and receive other benefits and privileges of employment.