DIRECTOR OF REVENUE CYCLE (PFS/HIM)

Req # 4385 DEPARTMENT: Patient Financial Services/Health Information Management REPORTS TO: Chief Financial Officer JOB SUMMARY It is the expectation that this position serves as a leader to the Patient Financial Services (PFS) and Health Information Management (HIM) staff including Billing/Follow-up, Posting, Patient Access, Customer Service, HIM Techs, and Coding.
This person will provide leadership, staff development, and supervision related to Revenue Cycle.
The position will work with other functional facility leaders and Senior Leadership to identify weakness in the Revenue Cycle process.
The position will also interact heavily with staff and vendors to address process flaws or weaknesses that are causing collection issues on the back end of the Revenue Cycle.
It is essential for this position to review points of A/R build up with staff and vendors, identify the cause, and help implement a solution.
JOB REQUIREMENTS College or University degree required or applicable experience.
EXPERIENCE Five years of working experience in leadership in a healthcare facility or other applicable experience.
SKILLS Computer and general office skills required.
Well-developed written and verbal communication skills necessary.
Mathematical and numerical skills necessary.
Mechanical aptitude helpful.
Organizational skills required.
Capable of sound business practices that may influence sales representatives to the advantage of the CRH’s purchasing program.
Needs to have a good professional rapport, and good interpersonal communication skills.
ESSENTIAL FUNCTIONS: Work closely with CFO to continually evaluate the activities of revenue cycle, shifting strategies and tactics as necessary.
Regulatory and billing knowledge required for CAH Hospital, Provider Based, Free Standing Clinic, RHC Clinics, Swing Bed Billing, and Payor Enrollment.
These duties are inclusive of monitoring services performed at all locations to ensure regulatory, billing and coding compliance.
Collaborate with Medical Staff office and applicable operational leaders to support the payor enrollment function.
Strong leadership managerial skills, ability to plan, delegate, monitor and improve work performance.
Demonstrates sound judgement, patience, and maintains a professional demeanor at all times Monitor and ensure achievement of Revenue Cycle Scorecard, and manage internal processes to achieve the goals of the scorecard.
Director should also facilitate support and functions needed from billing support vendor.
Identify, examine, and analyze patterns of rejections, partial denials, or denials from third party payers and implement changes.
Benchmark the ongoing accounts receivables, and works with staff when key indicators show that benchmarks are not being attained.
Implement revenue cycle operational/process best practices across CRH, ensuring consistency once adopted.
The areas of review will include but are not limited to POS Cash, admitting and clean registration rates inclusive of offsite locations, billing, authorization, re-classes, appeals and rebills.
Supports the revenue for the health system through maintaining a compliant and defensible Charge Master (CDM), claim integrity and charge reconciliation process.
Work with department managers to enhance the charging process, to enhance reimbursement, and to decrease denials.
Review charges for accuracy and completeness of procedural and diagnostic codes.
Examine, and analyze patterns of payment discrepancies utilizing the Payer Compliance Tool through billing vendor.
Escalate to Managed Care or appropriate party to resolve.
Maintain Compliance with all financial policies and procedures in the organization, inclusive of identifying changes needed, and presentation to the Board of Trustees on proposed changes.
Analyze and approve single case agreements/LOAs.
Facilitate Revenue Cycle Meetings (preparation, facilitation and follow up) inclusive of: Departmental Revenue Cycle Meetings Trended departmental reporting inclusive of offsite clinical departments, and provide education to department leaders on issues Revenue Cycle Scorecard preparation and review in conjunction with billing services vendor and support team.
Moved up Verify accounts to be turned over to an outside collection agency.
Manage bad debt process with collection agencies to include Medicare Reimbursable Bad Debt process and required log for the cost report.
Participation in Utilization Review Committee and Compliance Committee.
Prepare PFS/HIM budget, and maintain departmental productivity.
Maintain current knowledge of trends and regulations in the field of Health Information Management and Patient Financial Services.
Distribute information to the necessary committees, departments, and Administration.
Establish mechanisms for accessing, providing, and tracking requests for access to patient health information.
In addition, will ensure patient rights to inspect, amend and restrict access to their protected health information are granted.
Customer Service: Establish and administer a process for receiving complaints concerning the policies and procedures that fall under Revenue Cycle.
Document, track and take action on these complaints.
Function as Cody Regional Health’s Privacy Officer.
Ensure consistent action be taken for failure to comply with privacy policies for all employees on the workforce and for business associates.
Work in cooperation with human resources, administration and legal counsel as appropriate.
Audits PHI access periodically in accordance with policy.
Establish a privacy committee in conjunction with administration and the HIPAA project manager.
Assure the committee consists of relevant personnel for the purpose.
Audit PHI access periodically in accordance with policy.
Provide leadership to the Privacy Committee.
Provide information regarding Privacy for all departments and appropriate entities.
Oversee, direct, deliver and/or ensure training and orientation to all employees, volunteers, medical staff, business associates, etc.
regarding HIPAA privacy regulations.
Work with employees to ensure coordination and cooperation under the facility’s HIPAA privacy policies and procedures.
Represent the organization on privacy issues with external parties (state or local government bodies, business associates, etc.
).
Provide overall guidance and assistance in identifying privacy policies and procedures necessary for the organization.
Assure all necessary policies and procedures are written in plain, clear language, and are approved and distributed.
Stay current on federal and state privacy laws.
Routinely complete privacy gap analysis of current laws with organization compliance.
Ensure the facility meets HIPAA privacy standards deadlines.
SECONDARY FUNCTIONS: Responsible for dispensing and balancing of petty cash.
In charge of requisitions for PFS and HIM.
Attend department manager meetings.
Attend educational workshops.
Coordinate educational opportunities for revenue cycle staff and track completion of courses.
Responsible for storage and accessibility of all records as required by the state and federal laws.
May be requested to perform other related duties for which the individual is qualified.
Educate CRH staff on admission policies and monitor compliance.