Sr. Dir, Patient Financial Ser - ECU Health

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

The Senior Director oversees the Business Office functions including the billing, follow-up and collections of professional and hospital patient accounts, compliance with third party payer regulations, employee productivity and ongoing improvement to key revenue cycle indicators. These key indicators include but are not limited to; AR days, billing, claims edits, CFB, and cash collections goals related to patient account management.

This position is responsible for personnel development, implementing and maintaining Business Office policies. Works collaboratively with leadership to drive transformation and the associated change efforts necessary to manage the central business office services including management of outsource services.

Responsible for leading strategic revenue management initiatives to achieve the requisite outcomes associated with improved patient, physician, payer, and associate experiences. Collaborates with physicians, care providers, departmental leaders and practice management personnel to achieve performance goals.

Coordinate and champion projects while acting as a subject matter expert to establish system wide standardized policies and processes based on best practices for the front, middle and back-end functions of the revenue cycle. Maintains inter-department communications with all levels of personnel in order to define system requirements, set priorities, train system users and explain new concepts.

This position will work closely with all Revenue Cycle staff, internal/external operational leaders, patients and physicians. Coordinate activities with other departments and is expected to demonstrate, through plans and actions, that there is a consistent standard of excellence.

Responsibilities

Essential Accountabilities:

1. Developing and recommending potential organizational policy changes to the Vice President of Revenue Cycle Management; then once committee approved following through with implementation.

2. Assist with the development of budgets and monitoring of department operations to achieve goals within budget.

3. Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.

4. Oversees account statuses based on Days on AR, DNFB, CFB and communicate to billing management expectations and accountability.

5. Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS.

6. In conjunction with operations, reviews and enhances insurance verification, coding review, billing, and collection processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current workflow.

7. Reviews, monitors, and recommends updates to the Clinics fee schedule to maintain fees at levels that maximize reimbursement.

8. Regularly interacts with vendors while monitoring performance and contractual obligation. Works with the management team to establish A/R and industry performance metrics and monitoring and reporting on performance against established metrics.

9. Review performance data that includes financial and activity reports and spreadsheets to monitor and measure departmental productivity, goal, achievement, and overall effectiveness.

10. Attends monthly leadership meetings and/or other meetings as directed. Disseminates information from Vice President to department managers, supervisors, and staff. Schedules and leads monthly team meetings.

11. Works in conjunction with the Vice President on provider concerns and questions around RVUs, coding, and billing.

12. Partner with Finance to analyze reimbursement impacts on financial performance and support budgeting processes.

13. Stay current on federal and state regulations related to reimbursement and billing for durable medical equipment.

14. Work closely with legal and compliance teams to ensure adherence to all applicable laws and guidelines.

15. Establishes objectives to accomplish physician practice and hospital service line goals, as applicable.

16. Identifies opportunities and works toward cost reduction.

17. Improve in days to bill, days in accounts receivable, days of cash on hand, bad debt expense, timeliness in charge capture, avoidable losses.

18. Deploy a comprehensive management toolkit and report card metrics to enhance performance in key indicators.

19. Interviews, hires, trains, evaluates and develops subordinate management staff in accordance with defined policies and objectives.

20. Sets standards for conduct of work as well as for the required performance and supervises compliance with such standards.

21. Accountable for and models a culture of excellence for the department.

22. Provide feedback to management team regarding potential changes or enhancements to improve staff performance and ensure work quality has a positive impact on the revenue cycle.

23. Ensures that staff receives information by developing and implementing a communication plan with staff input.

24. Participates in leadership growth and development.

Minimum Requirements

Required Education: Bachelor's Degree and/or Minimum of 5 years of leadership experience 15 years leadership experience in a directly related role.

Preferred Education: Master's degree and/or Minimum of 20 years leadership experience in a directly related role.

Required License: Coding Certification or RHIT

Preferred License: RHIA

Required Experience: Minimum of 8 years' experience in a large academic/community group practice, and multi-hospital system with emphasis on back-office functions (claims submission, A/R follow-up, customer service, and cash services).

Solid understanding of Epic and EPIC business tools, to include use of Resolute, Prelude, Cadence and MyChart. Thorough understanding of EDI standards for electronic claims submission.

Must have strong knowledge of medical insurance billing and collections,CPT, ICD-10, and HCPCS coding as well as an overall knowledge of managed

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.