This position will support the effective and efficient operations of the GBMC Revenue Cycle for both Hospital and Professional Fee receivables and ensure continuous quality improvement efforts. This Position reports to the CFO and works with the CFO in the implementation and direction of the complete revenue cycle process across the hospital and all physician practices.
Education:
Master's Degree required
Licensure:
CPA
Epic Certification Desirable
Experience:
10+ years managing Revenue Cycle Department in within a health system or large private practice.
Skills:
- Experience with latest generations of hospital receivable, practice management and EMR systems.
- Experience creating, implementing and maintaining Policies and Procedures for an organization or department with a minimum of 50 people.
- Experience managing multiple office locations.
- Experience managing all aspects of revenue cycle from initial patient contact through successful outcomes.
- Excellent Conflict Management Skills
- Advanced Computer Skills and Experience including high level excel reporting, importing data from billing software into reports, understanding of operating systems and programming language such as SQL.
- Strong leadership and communication skills.
- Experience with contract management systems desirable.
Principal Duties and Responsibilities:
- Ensures regular meetings of the RCM including those individuals responsible for:
Operations
Electronic Medical Records and Scanning
Accounts Receivable
Charge Entry
Quality Control
Coding and Documentations
Contract compliance
- Facilitate communications and teamwork among various organizational functions in RCM.
- Works with operations providing training, policies and procedures and support to ensure optional efficiency and cost containment initiatives for the RCM
- Facilitate continual education and training for RCM involving:
Proper coding and documentation
Billing policies and procedures for all carriers in all states including government carriers
HIPAA
Compliance - Fraud and Abuse
- Provides Reports indicating the key financial and productivity metrics including but not limited to:
Denial Reports
Actual Payments from 3rd Party Payors compared vs. Contracted Rates
Net Collections
Gross Collections
Aging Accounts Receivable
Staff productivity benchmarks
- Work with Finance Department to ascertain budgeted revenue on a monthly basis based on contracted rates and expected collection percentage. Establish benchmarks of productivity and effectiveness for all functions of the RCM (utilizing resources including but not limited to comparison with similar entities, MGMA, HFMA benchmarks).
- Review audits of work performed by all functions of RCM.
- Present statistics of productivity and efficiency to Executive staff providing comparisons to benchmarks.
- Oversee the appraisals, formal and informal, of all individuals in the RCM.
- Oversee Records including but not limited to:
Training and mentorship of Supervisor
Tracking and trending of productivity and quality
Scanning of all records from sites and satellite operations
Timely entry of records into scanning system from the date of service
Ensure all charts are reconciled with cases performed by end of month
Providing missing or illegible information to Operations for accurate charge entry
- Oversee Charge Entry including but not limited to:
Training and mentorship of Supervisor
Tracking and trending of productivity and quality
Timely entry of charges between date of service and date of entry
Apportioning work volume
Utilizing contract management systems and procedures
- Oversee Accounts Receivable including but not limited to:
Training and mentorship of Supervisor
Tracking and trending of productivity and quality
Tracking of AR and collections tracking aberrations
Instituting best practices
- Oversee RCM Operations including but not limited to:
Weekly meetings with management of Operations
Visits to facilities reviewing best practices for RCM
Optimization of utilization of CBO
Ensuring responsiveness of RCM Operations to requests for information and direction
- Oversee IT requirements for RCM including:
Optimization of the billing, scanning and other IT utilized within RCM
Ensure utilization of EDI (electronic transfer of claims) is optimized and all issues are logged, tracked and resolved
Ensure the electronic transfer of claims to all third-party payers in all states are investigated and properly set up and operational
Ensure contracted rates of all third-party payers and all products within third party payer contracts are entered into the system
Oversee the EFT with all third-party payers in all states ensuring we are optimizing implementation of the electronic transfer of claims
- Oversee and direct managers at all satellite offices including but not limited to:
- RCM activities
- Logistics (US)
- RCM interactions
- Expansion of personnel
- Operational issues
- Work with Project Managers to direct and manage Revenue Management and IT issues to commencement of new services and for on-going operations.
- Develop team building skills and programs recognizing and directing individuals including incentive plans, bonuses, goals and objectives.
- Handle management reporting and presentations.
- Work together with Managed Care Contracting to ensure revenue is collected from all third-party payers in a timely manner in accordance with contracted rates and take action to resolve the issues.
- Work together with Managed Care Contracting to distribute contracts negotiated and educate staff on applicable items of the contract affecting revenue management.
- Work with Managed Care Contracting to communicate credentialing of physicians with various third-party payers with various Professional Corporations (P.C.s).
- Manages human resources within established productivity guidelines and the personnel budget. Facilitates training and development efforts. Maintains employee competencies. Monitors and reviews work performance of the staff. Interviews and selects personnel.
- Prepares the budget for areas of responsibility, preparing the operating budget and making recommendations for capital budget in consultation with appropriate Hospital staff. Maintains inventory and analyzes cost of supplies and services. Manages accounts payable issues.
- Provides input on major variances in the budget.
- Serves on the following committees; Clinical Operations Team, Billing compliance, Revenue Advisory and Cadence Advisory.
- Oversees the annual update of the fee schedule and related RVU tables. Approves increases to fees in order to insure maximum reimbursement under established contracts.
- Provides guidance on reimbursement and related billing issues to the service line administrators when developing new services or practices.
- Works closely with compliance to help facilitate audits billing activity, of provider activity and the related action plans.
- Meets with providers/provider group to provide education and updates on coding, documentation and other billing related issues.
- Works closely with Finance to insure cash is properly accounted for and reconciled.
- Leads the RCM team in IT projects including new installs and upgrades. Provides testing and training input.
- Report on department activity, accomplishments and initiatives at Management Meetings.
- Manage assigned projects or perform additional activities as may be required.
Pay Range
$177,768.29 - $319,982.93
Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.
Equal Employment Opportunity
GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.