SUPERVISOR-PFS - Tri City Healthcare District

Tri-City Medical Center has served San Diego County’s coastal communities of Carlsbad, Oceanside and Vista, as well as the surrounding region for more than 60 years and is one of the largest employers in North San Diego County. Tri-City is administered by the Tri-City Healthcare District, a California Hospital District. As a full-service acute care public hospital with over 500 physicians practicing in over 60 specialties, Tri-City is vital to the well-being of our community and serves as a healthcare safety net for many of our citizens. The hospital has received a Gold Seal of Approval® from the Joint Commission showcasing a commitment to safe and effective patient care for the residents of the community. 

Tri-City Medical Center prides itself on being the home to leading orthopedic, spine and cardiovascular health services while also specializing in world-class robotic surgery, cancer and emergency care. Tri-City’s Emergency Department is there for your loved ones in their time of need and is highly regarded for our heart attack and stroke treatment programs. When minutes matter Tri-City is your source for quality compassionate care close to home. Tri-City partners with over 90 local non-profit and community organizations as part of our COASTAL Commitment initiative. Together we are helping tackle some of our communities’ pressing health and social needs.

Position Summary:

Responsible for the day-to-day operations of Patient Financial Services (PFS) department account receivable for a district hospital business office. This department is comprised of Collectors, Discrepancy Unit, Customer Service and Correspondence Representatives. Demonstrates extraordinary commitment to excellence by adhering to departmental excellence criteria.

Major Position Responsibilities:

The position characteristics reflect the most important duties, responsibilities and competencies considered necessary to perform the essential functions of the job in a fully competent manner. They should not be considered as a detailed description of all the work requirements of the position. The characteristics of the position and standards of performance may be changed by TCMC with or without prior notice based on the needs of the organization.

• Maintains a safe, clean working environment, including unit based safety and infection control requirements.
• Supervises the Patient Financial Services account receivable department. Monitor, manage, and track the accounts receivable, billing and cash collections of Tri-City Medical Center (TCMC) billing office. Identify problems and trends that require action plan and develop and/or recommend an action plan.
• Maintains and reviews reports that are specific to accounts that may have insurance or denial codes.  Reviews edits on electronic transfer of claims to insurance carriers for payment. Monitors contractual payment and patient payment arrangements.
• Reviews high dollar accounts that have reached stop loss and works with the discrepancy unit to attain the health plan reimbursement.
• Reconciliation of daily receipts from cashier, reviews accounts for bad debt, outsourcing agency, refunds and credits.
• Conducts staff meetings and individual or team quality sessions.  Coaches staff that require additional education.
• Supervises and monitors the workflow of the all PFS staff for accuracy and continuity.  Demonstrates knowledge of accounts receivable posting and balancing procedures. Must be detailed oriented and demonstrate ability to audit and reconcile cash reports. 
• Demonstrates in-depth knowledge of payment appeals processes. Works closely with staff to maintain in depth knowledge of all functions performed in the department.
• Responsible for all compliance issues in regards to patient confidentially, health plan and departmental policy and procedures.
• Processes and reviews all refunds, contractual adjustment and credit balance for accuracy from the PAR or outsource vendors.
• Ensures accurate account handling in accordance with government, contractual and hospital procedures.  Reviews, approves and signs refunds and administrative adjustments up to signature approval.
• Works collaboratively with Information Systems, Patient Registration, Utilization Management and other internal departments in resolving registration, reimbursement, and collection.
• Monitors all customer service related functions, proposes related processes improvement changes. Interfaces with operations staff in process improvement activities for the department.  Assists the PFS Manager in all aspects of employee training and development.
• Interviews, selects and recommends applicants for hire. Provides orientation and hands on training to new hires and continuous training of existing staff through staff meetings and training seminars. Responsible that each employee understands and has a clear understanding of the scope of the position.
• Establishes performance criteria for all staff, which includes measurable performance standards. Conducts periodic performance evaluations.
• Schedules employees to provide adequate coverage for all holiday, illnesses, and vacations and verify staff time cards for payroll processing.
• Governmental Responsibilities
• Ensure staff productivity of 50 plus accounts per day
• Evaluate reports weekly to identify and assign for resolution within specified time frame:
  • Accounts with payments in government financial class.
  • Accounts greater than $25k
  • Accounts over 60 days
  • Accounts over 365 days
  • Medicare and Medicaid credit balances and bad debts

Qualifications:

• Minimum of 4 years of experience in hospital patient accounting, required.
• Minimum of 3 year’s progressively responsible for staff, including the ability to train, mentor and coach employees in the healthcare industry, required.
• Experience in working and using Microsoft Word, Excel and Outlook and familiar with a billing and accounts receivable software as it relates to healthcare, required.
• Must present oral and written communication skills that will effectively have a positive tone and or approach to staff and other TCMC employee’s and management, required.
• Can produce and invite human relations’ to the department and to include skills as; listening, conflict resolution, coaching, and team building, required.
• Must have ability to demonstrate flexibility in response to unexpected change in work volume and hospital staffing needs, required.
• Process oriented skills with ability to handle multiple projects simultaneously by prioritizing responsibilities and meeting deadlines required, required.
• Ability to ensure the confidentiality and rights of patient’s and/ the confidentiality of hospital and departmental documents required.
• Demonstrates in-depth knowledge of all third party/government authorization, billing and reimbursement rules and regulations, required.
• Demonstrates knowledge of accounts receivable posting and balancing procedures, required.
• Must be detail oriented and demonstrate ability to audit and reconcile cash reports.
• In-depth knowledge of CPT, HCPCS, DRG, ASC & other coding requirements, required.

Education:

• Bachelors degree from an accredited university or equivalent work or equivalent work experience in a hospital billing and collections, required. 

Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work. 

*Salary/Hourly wage range for this position is posted.  Actual pay will be determined based on verified experience as well as internal equity.

TCHD is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, sexual orientation, or gender identity/expression), age, marital status, status as a protected veteran, among other things, or status as a qualified individual with a disability