Director|Patient Financial Services and Professional Billing, Full Time

Memorial Health•Marysville, OH

33d

About The Position

We are looking for a Director, Patient Financial Services & Professional Billing to join our collaborative team at Memorial Health! What You'll Do: 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. Strategic Direction and Leadership for the Following Departments/Functions: Patient Financial Services, Professional Billing and Hospital Contract Modeling, and all related systems. 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. Payer Relations and Contract Administration 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. Maintains knowledge of contract provisions in other third party managed care contracts. Analysis and Reporting 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. Business Systems Oversight 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. Management of Extended Business Office (EBO) and Collection Agency Processes: 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. Other 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.

Requirements

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.

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.
Strategic Direction and Leadership for the Following Departments/Functions: Patient Financial Services, Professional Billing and Hospital Contract Modeling, and all related systems.
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.
Payer Relations and Contract Administration 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.
Maintains knowledge of contract provisions in other third party managed care contracts.
Analysis and Reporting 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.
Business Systems Oversight 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.
Management of Extended Business Office (EBO) and Collection Agency Processes: 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.
Other 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.