Director, Patient Financial Services (PFS) - Healthcare CBO

Guidehouse•San Antonio, TX

12d•Onsite

About The Position

The Director, Patient Financial Services (PFS) is responsible for the overall management of Hospital Client PFS department operations, including patient accounting, credit and collections, denial management, and other key revenue cycle activities. The Director establishes and achieves departmental objectives, manages patient-account billing and follow-up, ensures compliance with third-party payer regulations, and works with company resources to improve key revenue cycle indicators and maximize revenue and cash flow. The position is preferred to be based onsite in the San Antonio office, but candidates outside San Antonio are also considered. The role requires broad knowledge of healthcare billing and finance, front- and back-end billing operations, billing and coding regulations, patient registration and eligibility, third-party verification, electronic claims and authorizations, accounts receivable follow-up, denial management, and HFMA MAP metrics. The Director reviews operational data, investigates issues and trends, communicates findings to Revenue Cycle leadership, and facilitates resolution. The role also collaborates with Finance, Hospital PFS, Managed Care, and other Revenue Cycle leaders; participates in committees and task forces; prepares and chairs project meetings; maintains knowledge of regulatory standards; and contributes to PFS policies and procedures. The Director plans, coordinates, implements, and controls Hospital Billing and Collection services in a complex centralized environment. Staff responsibilities include hiring, reviewing, disciplining, and separating employees; monitoring and reporting productivity; ensuring compliance with company policies and procedures; monitoring time-off requests; and filling in for Managers. Other related job functions may be assigned.

Requirements

Bachelor's degree and at least 12 years of prior relevant experience, or Associate's degree and at least 14 years of prior relevant experience; relevant experience may substitute for formal education or an advanced degree.
Relevant experience may come from a healthcare provider, payer, CBO, business office environment, or outsourcing company.
Experience in accounts receivable follow-up, denial management, and driving client engagement.
Extensive experience with healthcare hospital billing systems, including electronic claims and authorizations.
Knowledge of front- and back-end billing operations and billing and coding regulations.
Proficiency with registration, eligibility, third-party verification, billing, and collections.
Comprehensive knowledge of healthcare, billing, finance, and accounting principles.
Detailed knowledge of billing technical elements, including standard forms and data, coordination of benefits, third-party liability, billing, and collections.
Comprehensive knowledge of HFMA MAP metrics.
Ability to review data, assess operational impacts, identify trends and opportunities, and facilitate issue resolution.
Ability to prioritize and manage numerous tasks simultaneously.
Ability to understand financial systems and patient accounts and detect and resolve accounts receivable problems.
Ability to plan, coordinate, implement, and control Hospital Billing and Collection services and function effectively in a management role in a complex centralized environment.
Ability to collaborate, mediate, and resolve issues between Finance and Hospital PFS.
Ability to handle multiple concurrent activities and change.
Excellent verbal, written, analytical, and interpersonal skills.

Nice To Haves

Preference for candidates located in San Antonio or willing to relocate.
Understanding of healthcare revenue cycle, payer contracts, and regulations affecting reimbursement for healthcare services.

Responsibilities

Manage Hospital Client PFS department operations, including patient accounting, credit and collections, denial management, and related revenue cycle activities.
Define and achieve departmental objectives and manage billing and follow-up of patient accounts.
Ensure compliance with third-party payer regulations and applicable standards pertaining to Hospital PFS.
Work with company resources to improve revenue cycle indicators and maximize revenue and cash flow.
Review data to determine operational impacts and necessary actions; elevate issues, trends, improvement areas, and opportunities to management.
Research identified issues to determine whether they are isolated or part of a trend, and coordinate communication and resolution with Revenue Cycle leadership.
Establish collaborative relationships with other Revenue Cycle leaders.
Work with the Managed Care Department on underpayment analysis.
Attend and participate in assigned committees and task forces; serve on department or institutional committees as requested.
Prepare materials for project meetings and, when experienced, conduct and chair them.
Maintain current knowledge of regulatory standards that may affect processes and systems.
Seek opportunities for individual growth and development, including meetings, conferences, and courses as required.
Participate in developing PFS policies and procedures.
Collaborate, mediate, and resolve applicable issues between Finance and Hospital PFS.
Plan, coordinate, implement, and control Hospital Billing and Collection services in a complex centralized environment.
Hire, review, discipline, and separate staff; monitor and report daily and monthly productivity; ensure team-member compliance with company policies and procedures; verify and monitor time-off requests; and fill in for Managers.
Perform other job functions related to the position.