Establishes priorities and functions as a resource to staff on project management.
- Serves as the liaison between the IT design/build/testing team, the deployment team, as well as revenue cycle and financial business owners.
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10 |
Supervises implementation of revenue cycle management and analysis methods, systems, and workflow enhancements, with responsibility for meeting project goals, objectives, and timelines within budget.
- Maintains appropriate programs and infrastructure to ensure a high level of customer satisfaction that includes patient friendly billing techniques, prompt service recovery and creation of an ideal patient experience. Investigates and promptly resolves patient problems or reported service dissatisfaction. Works with practices and staff to ensure compliance with all supporting documentation necessary for successful claims submission and reimbursement. Produces and communicates scorecards/dashboards on professional fee billing and collection activity with detailed reporting by physician/service line and/or department.-Ensures physicians are credentialed with facilities/payors so revenue can be billed in compliance with laws and regulations.
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20 |
Selects, develops and evaluates staff or provides input to management to ensure the efficient operation of the healthcare revenue cycle department. Recommends salary actions, terminations, performance ratings and other human resources matters.
- Determine staff needs; hire, assign duties, evaluate performance, approve time records and requests for time off, resolve complaints, and discipline as appropriate. Develop and train staff; mentor, and provide career coaching; motivate staff, individually and as a group. Remain current on university procedures related to recruitment, compensation, discipline, complaint resolution and equal opportunity guidelines. Facilitates staff meetings.
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10 |
Distributes assignments, and interprets and administers policies as they affect subordinate staff. Monitors, reviews, and documents new and ongoing programs in revenue cycle management to ensure that subordinate staff reports, analyses, and related work products are accurate, consistent, and compliant.
- Perform high level financial analysis supporting the financial goals of the clinical enterprise. Independently research/recommend financial policies, implement innovative business procedures, and provide financial forecasting using market trend analysis.-Continuously identifies changes in reimbursement patterns that impact overall collection rate, working with revenue generating area representatives.
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10 |
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Assists with the development of efficient workflows for capturing data from admitting/registration, charge master, decision support, reimbursement, medical records, business office and clinical departments. Recommends improvements in existing practices to accelerate revenue cycle functions and maximize reimbursement and revenue.
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10 |
Coordinates the deployment and monitoring of training program (job tools, aides and learning delivery methods). Ensures subordinate staff provides departments with ongoing education and training on revenue cycle management policies and procedures.
- Stay abreast of changing government billing regulations, new programs and revenue opportunities. Ensures managers, supervisors, staff and billing vendors are current with required codes, bill forms, electronic claims processing tools and documentation rules.
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5 |
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Supervise/direct all activities related to the professional billing and collections of the billing vendor. Supervise/direct to ensure appropriate encounters, claims submission and appropriate payments are received. Interpret financial reports from the vendor and make recommendations for improvement. Provide high level financial review on key performance indicators from the vendor that include, but are not limited to, A/R management metrics for bad debt and A/R less than 120 days. Monitor and make recommendations if metrics are less than targets. Evaluate practices, physician finances and productivity, explore best practices and formulate recommendations and present options. Review, analyze and recommend negotiating contract rates and provide analysis on reimbursements levels. Provide input and make a selection on service contracts that support billing and collections. Ensure contract performance metrics are defined and met, fees are competitive, and concerns are addressed/corrected.
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20 |
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Approves documented standards/practices to manage vendor's performance; ensure timely and accurate cash posting and application of accounts receivable adjustments, write-offs, account transfers, and appeals. Approves write-off, adjustments, refunds, and referral of accounts to collection agency. Understands and applies third party payor contracting terms and educates billing vendor and revenue management staff on system edits and rules, monitors actual payments and denials against contractual terms and directs billing vendor to work with payors to reconcile under or over payments. Oversees the operational management of the revenue management functions of UCR Health. Manages and meets the operating budgets for assigned areas. Prepares departmental financial, operating and performance variance reports, and maintains internal policies and procedures.
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15 |
