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Memorial Health Ohio · 1 month ago

Director|Patient Financial Services and Professional Billing, Full Time

Marysville, OH

Full-time

Onsite

Lead/Staff, Director/Executive

4+ years exp

Memorial Health Ohio is seeking a Director of Patient Financial Services & Professional Billing to join their collaborative team. The role involves overseeing initiatives to improve net revenues and compliance while managing the Patient Financial Services and Professional Billing departments.

Health CareHospital

Growth Opportunities

Responsibilities

Management of Patient Financial Services and Professional Billing Departments

Responsible for overseeing initiatives to improve net revenues, reduce patient accounts receivables and improve compliance in support of organizational goals

Ensures billing practices are consistent with internal policies and external requirements of payors

Identifies and analyzes billing trends and make appropriate recommendations to leadership

Maintains current working knowledge of federal and state regulations regarding the revenue cycle

Assist with projects related to revenue opportunities, manage all aspects of patient billing, appeals, denials management, payor variances, cash posting, bank reconciliation, statement processing, cashier and patient financial counseling

Provides status of organization’s billing/claims collection performance to Senior Director

Informs Senior Director of any significant upstream issues that inhibit patient billing and reimbursement. Monitor progress to resolution

Monitors team performance to ensure timeliness, accuracy, and compliance standards are being achieved

Facilitates timely and complete resolution of all customer questions and concerns

Motivate employees to accomplish department goals in support of the Hospital’s strategic plan

Monitors staffing productivity measures and ensure employee accountability

Provides mentoring, training and development for management team and staff

Monitors expenses to ensure within approved budget

Participates in staffing interviews, employee selection, performance evaluations, and disciplinary actions

Ensures adequate controls are in place for all reporting departments, e.g. develop and maintain policies, procedures, and guidelines

Chair of Revenue Cycle Denials Committee and member of the Revenue Cycle Executive Committee

Provides subject matter expertise to ensure data validity and accuracy in payer reimbursement models

Monitor reimbursement variances by payer, service line, and provider; perform root-cause analysis to recommend corrective actions

Develops and fosters strong payer relationships

Maintains a comprehensive knowledge and understanding of all Hospital and Memorial Medical Group payer contracts, terms and reimbursement

Maintains a comprehensive knowledge of medical policy as applies to each payer

Collaborates with payers to resolve claim issues (authorization denials, claim rejections, claim denials, etc.) in a timely manner

Compiles and analyzes key performance indicators (KPIs) across hospital and professional billing departments to identify operational improvement opportunities and provides to Senior Director

Compiles and prepares data, reports and analyses for various Hospital departments and directors

Oversight and assist with data collection for Hospital Care Assurance Program (HCAP), Hospital Charity Care (CC), Medicare and Medicaid Cost Reports, Bad Debt report and annual payer Credit Balance Reviews

Analyze reports and outcomes as they pertain to revenue cycle management; to include but not limited to monitoring of accounts receivable (A/R), claim denials and appeals, late charges, key performance indicators. Report to Senior Director as appropriate

Develop, maintain, and present routine and ad-hoc revenue cycle performance reports, including AR trends, billing lag, denial patterns, cash collections, charge capture accuracy, and payer performance. to facilitate decision making processes

Provides scheduled standard reports to client leadership

Create dashboards and visualizations that translate complex billing and reimbursement data into actionable insights

Prepare monthly memorial medical group (MMG) financial dashboard

Prepare monthly cash projection reporting

Use predictive analytics to identify trends such as high-risk claims, likely denials, or underpayments, and drive proactive resolution strategies

Translate analytical findings into operational plans, driving measurable improvements in billing efficiency, clean claim rate, denial reduction, and overall revenue integrity

Ensures systems dictionary files, data elements, interface and mappings are maintained

Facilitates successful system implementations, conversions, and upgrades for revenue cycle applications

Assesses new technology, performs vendor assessments, and creates ROI analyses and recommendations for leadership

Maintains access to and oversees administration of all payer websites

Ensures adherence to regulatory and compliance

Oversight of file transfers, ensure transfers are set-up and secure in accordance with Health Insurance Portability and Accountability Act (HIPAA) requirements

Responds to emergencies outside normal work hours

Exhibits behaviors reflective of Memorial’s core values: Compassion, Accountability, Respect, Excellence, and Service

Demonstrates regular and predictable attendance

Attends all mandatory education and in-services (i.e., team training, safety, infection control, etc.); completes mandatory health requirements

Employee performs within the prescribed limits of the hospital’s and department’s Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer, or the hospital hotline

Performs other duties as required or assigned

Qualification

Revenue Cycle ManagementHealthcare Regulations KnowledgePayer RelationsData AnalysisMicrosoft ExcelFinancial ReportingLeadership SkillsMentoringTeam ManagementCommunication Skills

Required

Bachelor's Degree with an emphasis on finance, accounting or healthcare administration

Four (4) years of core Revenue Cycle experience

Skill in directing the work and activities of staff with the ability to effectively delegate

Skill in providing leadership and in mentoring staff

Knowledge of healthcare trends and CMS regulations

Knowledge of and proficient skill in the use of core PC-based Microsoft Excel, Word, PowerPoint and Access functions

Knowledge of and a broad understanding of healthcare operations and key cost and revenue drivers

Knowledge of all aspects of the revenue cycle to include patient access and data input; billing patients and third-party payers; follow up collections from patients and third-party payers; denial avoidance and management; cash posting and reconciliation; contract management; revenue integrity; and vendor management