Providence St. Joseph Health is calling a Director, RCS Enterprise Underpayments Management: Commercial . This role is open to candidates residing in Alaska, Washington, Montana, Oregon, California or Texas.
Applicants that meet qualifications will receive a text with an additional question from our Modern Hire system.
We are seeking a Director, RCS Enterprise Underpayments Management: Commercial to be responsible for all aspects of Revenue Cycle underpayments with direct operational accountability for Commercial underpayments across the enterprise. The Director is responsible for assisting in the development of a strategic plan to establish an underpayments center of excellence (COE) and oversee COE operations and meet the goals of the underpayments management program, in partnership with the leaders of PSJH RCS Services. This position will have responsibility for participation in the leadership of RCS Senior Managers and COE Caregivers to ensure underpayment activities are standardized across Providence St. Joseph Health, and that all policies, procedures, and strategies adhere to the guidance and vision of the centralized Revenue Cycle function. The Director will continuously audit workflows, assess risk and propose improvements with a focus on automation and analytical techniques to eliminate workflow variations and support Real Time/data-driven discernment to produce consistent results.
Partners with the Executive Director, RCS Enterprise Underpayments Management and other system level leaders on Revenue Cycle process improvement, training, technology innovation, analytics, compliance, contracting and vendor management. The Director of the RCS Enterprise Underpayment Management will continually review the current state and work with the Executive Director RCS Enterprise Underpayments Management, the Associate Vice President of Denials and Underpayments and other PSJH Senior Revenue Cycle leaders to move the organization to leading practices. The Director RCS Enterprise Underpayments Management is responsible to ensure policies and procedures are current and enforced, business practices are compliant, and a high level of patient and customer satisfaction is maintained across the region. Promotes an environment shaped by health, healing, hope, diversity, and mutual respect. Is self-directed and requires minimal supervision.
In this position you will:
Develop, evaluate, monitor and communicate the long and short term strategic objective of the revenue cycle underpayments function, ensuring consistency and alignment with the strategic objectives of the centralized revenue cycle organization, and PSJH. Responsible to achieve annual performance goals as established by the Chief Revenue Cycle Officer for PSJH.
Develop and execute a detailed plan to improve overall underpayment performance in the revenue cycle and to continually collaborate with patient access, HIM, case management, billing team and contracting leadership to improve registration accuracy, coding accuracy, reduce days in AR, increase cash collections, reduce bad debt, eliminate write-offs due to revenue process issues and improve customer and patient satisfaction.
Establish and maintain a best in class workflow for the timely follow-up, escalation and resolution of payment variance related issues. Develop and maintain a dispute resolution notification and escalation process to engage the appropriate PSJH leaders, including Payor Contracting and Legal, when pursuing payment variances at an enterprise level. This includes creating and overseeing a payment variance appeals submission and follow-up workflow and leading or participating in payor/Providence JOCs meant to escalate and address payment variances at Ministry, Regional and Enterprise levels.
Establish and maintain meaningful partnerships with insurance companies, medical groups and other third-party payors to aid in the timely recovery of additional reimbursement for hospital based services in accordance with executed third-party payor contracts and/or other applicable governing regulations or contracts.
Lead a team of analysts that will provide continuous audits of all related workflows including but not limited to: risks and risk mitigation, provider and payor compliance, information technology systems (internal and add-ons) and standard operating procedures with an eye towards optimization, automation and timely information exchange between key stake holders to drive performance.
Evaluate the Undperpayment COEs processes and base information technology infrastructure to streamline operations and perform as a strategic business partner to influence change and recommend new processes up/down stream of the Revenue Cycle process to reduce waste in line with Lean Six Sigma methodology and increase revenue.
Provide shared operational leadership to all ministries in the organization related to underpayments. Provide shared leadership and supervision to the areas of oversight.
Partner with other Revenue Cycle leadership to lead the development and implementation of policies, procedures and workflows which impact net revenue cash flow or performance efficiency across the Revenue Cycle function that align with the strategic direction and standardization for all of PSJH.
Partner with system wide Revenue Cycle leadership to develop process improvement opportunities, training, technology innovation, analytics, compliance and vendor management to meet underpayment improvement and maintain industry best practice needs.
Collaborate with other PSJH ministries and provides leadership in communicating consistent information and data regarding underpayment performance.
Collaborate with PSJH Contracting to understand contract specifics and provide PSJH Contracting with data to support negotiations with payers and development of contracting strategies. Develop relationships and collaborate with leaders at the payer level to improve appeal turnaround and dispute resolution.
Manage and oversee the development of technology solutions to improve efficiencies and reduce the delays in workflow processes.
Develop and insure that the activities of the underpayment processes are performed in accordance with state and federal regulations, mandated collection practices, all regulatory agencies including JCAHO, and are HIPAA compliant.
Develop and monitor an annual operational budget as well as any capital budget requests, and complete all fiduciary responsibilities.
Actively collaborates with the financial leaders across PSJH to ensure the goals and strategic initiatives are aligned and whenever feasible, operational procedures are standardized.
Qualifications:
Required qualifications for this position include:
Bachelors Degree in Business, Healthcare Management, or related field or equivalent educ/experience
10 years related experience in healthcare, revenue cycle or finance; 10 years leadership experience. Proven ability to work collaboratively in group settings with various stakeholders, including executive leadership and clinicians
Organizing, planning, facilitating, and coordinating skills
Excellent oral/written communication skills
Demonstrated success in leading large, complex change initiatives
Excellent leadership ability to include motivating & developing others
Excellent interpersonal skills and ability to work with all levels of management and staff
Preferred qualifications for this position include:
MBA or MHA
10 years leadership experience, preferably with responsibilities that span multiple entities
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