Responsibilities:
Oversee the formulation of provider contracts and all billing, collections, cash posting, and overall denials prevention.
- Ensures that provider contracts are processed to support accurate claims payments
- Ensures timely billing and follow-up is being executed by PFS staff
- Ensure that all revenue is being accounted for and charges rendered in a timely and accurate manner
- Assures contractual arrangements meet financial targets and legal/regulatory compliance requirements
Responsible for the operations of both PFS and Revenue Integrity (Charge and Reimbursement)
- Analyzes contract data and provides financial projections
- Provides input to strategic decisions that affect the functional area of responsibility
- Capable of resolving escalated issues arising from operations and requiring coordination with other departments
- Researching territories to identify gaps with our payer base and supporting the expansion into new markets
- Actively participate in establishing strategic business goals with the Leadership Team
- Develop and maintain periodic reports on the status of all contracts
- Assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes
Responsible for developing and maintaining productive payer and internal stakeholder relationships
- Responsible for the accuracy of supporting documentation for contracts and completing documents accurately
- Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, medical policy changes and reimbursement.
- Maintain excellent written and verbal communication with all internal and external customers around denials, payer engagement/escalation, and cash intake/performance.
- Effectively and professionally represent Norman Regional Health System to provider community
Internal communication and education regarding payer contracts, denials, root causes, and effective billing and cash performance
- Collaborates with internal departments to ensure staff are informed of new contracts, changes to existing contracts, changes to existing contracts and updates to the medical and billing policies of the payers we service.
- Provide cost analysis and utilization data to support leadership decisions
- Develop and maintain processes that provide timely notification of critical events (renewals, terminations and due dates contained within the agreements)
- Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy & billing policies.
- Assist with all contracting administration and projects, as needed.
OTHER FUNCTIONS
- Monitors and evaluates financial and productivity information to achieve operational benchmarks.
- Plans, analyzes and implements actions necessary to achieve established fiscal year department productivity benchmarks.
- Monitors progress of departmental operations, adjusting functions as necessary to achieve budget.
- Analyzes industry trends in the development of department operational needs.
- Collaborates with other departments to achieve organizational budget and revenue cycle benchmarks.
- Analyzes current operational functions and industry trends to validate benchmark targets. Defines and promotes new targets based on research and consideration of overall hospital operations.
Fosters the learning and development of staff to fulfill the current and future requirements of individuals and organization.
- Interviews, selects and hires the most appropriate job candidate. Seeks additional input from department members and delegates components of hiring process as appropriate
- Ensures department specific orientation, initial, and annual competencies are completed as per policy
- Clearly articulates expectations and monitors performance.
- Delegates authority and responsibility with the latitude to do a task independently. Defines parameters and lets others learn from mistakes in a safe environment.
- Devotes time to listen, provide coaching, and mentoring for individual development
- Identifies needs and provides developmental opportunities, assignments and training.
- Provides feedback for improvement in a timely manner and utilizes progressive discipline as needed
Collaborates with other departments to identify and resolve operational patient care issues.
- Acts as an expert resource for physicians, staff and management team.
- Uses problem solving strategies and a "win-win" approach to meet internal and external customer's needs.
- Listens to internal and external customers, uses a non-defensive approach, and resolves interdisciplinary issues.
- Trains staff to recognize and respond appropriately to the internal and external customer.
Actively supports and promotes the shared mission and vision of Norman Regional Hospital to achieve strategic goals.
- Plans, develops and implements new services/programs based on awareness of industry trends, organizational goals, and community needs.
- Solicits input and active participation from key internal and external partners to develop strategic planning initiatives and operational budgets.
- Develops, implements and communicates departmental goals in support of the strategic plan and measures progress toward achievement of goals.
- Responds to immediate events that can affect long term goals of the hospital systems and collaborates to change the strategic approach or re-evaluates business practices as needed.
- Maintains awareness of medical community relations and pursues opportunities to align the physician contribution with strategic initiatives.
- Utilizes mission as a compass for all departmental activities.
Develops and promotes employee satisfaction to facilitate positive patient and physician outcomes
- Proactively communicates to resolve potential issues before they occur
- Monitors and responds to physician, patient, and employee concerns in a timely manner
- Shares current department and organizational information with employees, utilizing a variety of communication methods
- Completes annual evaluations as per policy.
- Provides formal and informal recognition for the efforts and achievements of employees.
- Monitors and responds to physician, patient, and employee satisfaction surveys.
Performs all other job-related duties as necessary.
Qualifications:
Education
- Bachelor Degree, advanced degree preferred
Experience
- Minimum five (5) years related work experience required with three (3) years managerial experience preferred.
- Must have a broad based knowledge of hospital and medical group operations. Must maintain expert knowledge of payer behaviors and its application in a hospital setting. Must have knowledge of hospital and medical group contract management and financial information systems.
Preferred
Relevant certifications (e.g., CRCR, CHFP, or comparable).
Experience with Meditech and common revenue cycle / analytics platforms (e.g., FinThrive, VisiQuate, 3M), and with multi-EHR integration across hospital and ambulatory settings.
Experience in the Oklahoma / regional payer market and with multi-entity, multi-EHR (HB / PB / ASC) environments.
Master’s degree (MBA / MHA) a plus.
Compensation/Benefits
- $46.35-$75.70/hr depending on previous work experience.
- Benefits include medical, dental, vision, short-term disability, long-term disability, life insurance, paid time off (PTO), paid holidays, tuition reimbursement, scholarship opportunities, retirement plans, free parking, and opportunities for advancement.