In an environment of continuous quality improvement, the Director of Patient Financial Services is responsible for establishing and implementing strategies and tactics that will develop and continually enhance the business and market leadership of MHS. This position will take a lead role in developing and implementing a standard format for business development activity and facilitate the process across the health system. The Director of Patient Financial Services will lead business development processes to maximize the use of our resources. This position will be accountable for executing business strategies to increase volume, revenue and MHS's overall market share. This will be accomplished through aligning and connecting physicians and building relationships throughout the region that will be beneficial to the health system. The Director of Patient Financial Services develops and directs projects in conjunction with physicians, hospitals, ambulatory sites, other entities and outside management companies/consultants that target growth through volume, revenue and core market share. In addition, this position identifies, researches, and prioritizes new opportunities consistent with strategic goals of the strategy and business development division. Exhibits the MHS Standards of Excellence and exercises strict confidentiality at all times.
· Master's Degree in related field with a minimum of three years of management experience or Bachelor's Degree in related field with a minimum of 6 years management experience, Master's Degree preferred
· Must have four years of experience in implementing and maintaining audit and reimbursement programs, and developing new programs that increase net facility revenues
· Billing experience preferred
· Experience with Meditech 6.15 preferred
· Knowledge and understanding of all audit and reimbursement systems, Code Procedures, business software and computers, CPT coding, insurance billing and collection procedures
· Knowledge of accounts receivable functions, payroll/accounts payable processing systems
· Knowledge of general ledger accounts, DRGs, HFAP standards, and process improvement methodologies required
· Solid understanding of Medicare, Medicaid and managed care processes
· Ability to read, analyze, and interpret financial reports, contracts, and other legal documents
· Ability to work independently to achieve results
1. Reviews, analyzes, and evaluates business systems and user needs related to Patient Financial Services.
2. Maintains current knowledge on all compliant billing practices and ensures billing system meets current requirements from insurers and government/state programs.
3. Identifies, documents, tests, and creates processes to improve PFS systems and programs under the guidance of the Senior Director of Revenue Cycle and Chief Information Officer (CIO).
4. Supports and participates in the development and implementation of strategies, processes, and procedures designed to improve the overall effectiveness of PFS activities, including process automation and control, claims submission, follow-up, and cash collections.
5. Provides revenue cycle/billing management services to client/partners in all areas of the healthcare revenue cycle which includes:
a. Patient financial services (charge capture, pre-billing, billing, follow-up, cash posting, account resolution)
b. Patient access (scheduling, preregistration, insurance verification/financial counseling)
c. Registration/Admission (ED, inpatient, outpatient, ambulatory)
d. Health Information Management (transcription, coding, clinical documentation improvement)
e. Decision support and analytics
f. Productivity and quality management
6. Successfully leads and manages staff, supervises day to day operations, and maintains department budget.
7. Responsible for revenue cycle management, billing, collection and reporting of patient financial accounts.
8. Maintains knowledge of federal, state and private regulations for coding, reimbursement and data collection and reporting as required by Center for Medicare and Medicaid Services (CMS), and other regulatory organizations and payers and ensures staff are compliant with the regulations.
9. Maintains knowledge of various payers eligibility and benefit process and access to information and ensures staff are complaint with the processes.
10. Maintains knowledge of various payers pre-certification, certification, initial and ongoing authorizations for the agency programs and ensures staff are compliant with the processes.
11. Ensures the timely and accurate billing and processing of accounts receivable as well as prompt follow up of accounts while maintaining an acceptable level of days in receivable.
12. Ensures completion of billing and regulatory compliance audits and reports.
13. Collaborates and partners with revenue cycle team and other departments in order to facilitate resolution of process issues and implement world-class solutions.
14. Has the authority and responsibility to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, discipline, direct, or recommend such actions by using independent judgment.
15. Completes and conducts employee performance evaluations based on direct observation of their employee's job performance.
16. Granted authority to perform the supervisory duties and are held accountable for performing such duties.
17. Assumes all other duties and responsibilities as necessary.