Senior Director Billing Vendor Management

About the position

Under the general direction and guidance of the VP, Revenue Cycle, the Senior Director is responsible for developing standards and ensuring the integrity of the integrated professional and facility revenue charge capture. This includes all aspects of the Charge Description Master and fee schedule formulary(s), review and maintenance to optimize revenue generation, and maintain compliance with third party payer requirements; charge entry and reconciliation; collaboration with all service lines across the BMC Enterprise; policies and procedures development, modification and maintenance. The Sr Director also is responsible for developing a charge audit/capture/reconciliation process and ensuring charges are maximized for reimbursement. The Sr Director also provides oversight and response for governmental audits such as RAC, MIC, and Third Party Payer audits. The Sr Director also participates in compliance related activities and denials root cause and process improvement, as appropriate. The Senior Director is the primary representative and face of the Physician Business Office (PBO) to the organization, Faculty Practice Foundation and external billing vendors. The incumbent will lead and manage complex revenue cycle projects - drive performance and provide overall direction and oversight of the functional areas (Physician Business Office, Revenue Operations/Business Intelligence, and Shared Revenue Systems/Cash Processing) that support the organization's financial and operational goals. They will develop policies, procedures, and workflows related to revenue cycle functions throughout the practices in collaboration with the operating Departments. Ensures compliance with CMS regulations, BMC policies, and standards for third party payors. Fosters and promotes a culture of excellence in customer service to internal and external clients. Builds trust and collaboration amongst the team by enhancing employee engagement, addressing performance results, and providing coaching and mentoring.

Responsibilities

• Collaborate with the VP Revenue Cycle in defining vision, strategy and priority setting for areas of responsibility across the BMC System, including community hospitals.
• Work to standardize the processes and procedures throughout both the faculty practices as well as the facility.
• Conduct audits, on a periodic basis all areas treating patients to ensure all professional and facility billable charges are captured.
• Direct, set vision, and define roles and responsibilities for the Department, including training, delegating tasks, overseeing daily activities, mentoring, guiding through demonstration of best practices and offering opportunities for professional development.
• Develop and maintain methodologies to monitor departmental conformity to FPF and BMC standards related to charge posting, charge reconciliation and other billing related issues.
• Assess professional and facility charging and patient care documentation practices and procedures to ensure compliance with pertinent regulations and guidelines.
• Facilitate the dissemination of information regarding coding and reimbursement to the appropriate FPF and BMC management and staff.
• Provide communication and coordination with all departments regarding key charge capture functions.
• Oversee the management of the consolidated professional and hospital Charge Description Master (CDM), Fee Schedules, Charge Entry & Reconciliation efforts.
• Serve as the FPF and BMC representative for charge capture and revenue integrity functions.
• Utilizes a proactive leadership style to model and promote a culture of trust and collaboration.
• Responsible for effective identification of staffing resources, recruitment, allocation of resources, retention, recommending salary changes and corrective action/ progressive discipline.
• Holds all staff members accountable for following to regulations, BMC policies, HIPAA laws, CMS guidelines and statutes.
• In collaboration with the Faculty Physician Foundation practices, manages vendor relationships while defining and developing accountability to leverage vendor performance.
• Functions as highly visible, approachable and accessible leader.
• Creates a motivational environment. Provides challenging assignments and opportunities for development.
• Encourages staff to attend educational opportunities relevant to their position and supports their attendance.
• Assess and respond to current and future internal and external healthcare trends.
• Continually seeks opportunities for improving the delivery and support of the PBO revenue cycle activities and programs.
• Assures satisfaction among practices and other customer groups with the quality and amount of support provided.
• Actively engages in understand the job functions of staff as it relates to process flow across the practices.
• Ensure adequate training and education occurs to both providers and hospital departmental staff regarding accurate charge selection / entry and documentation requirements.
• Analyze and influence appropriate action in all areas of reimbursement.
• Oversee data analysis, trending and management reporting to substantiate positive, compliant net revenue impact.
• Oversee and manage payer relationships as related to defense audits.
• Ensure that controls are put in place to hold providers and hospital departments accountable for effectively managing charge capture and reconciliation processes.
• Develop controls and reporting processes related to audit issues, such as RAC audits.
• Oversees claims management, billing, accounts receivable management for the network of physician practices and practice sites.
• Understands EDI standards for electronic claims submission.
• Ensures compliance with payer agreements as they relate to credentialing.
• Provides oversight to denial management and disputed claims processes.
• Leads the management of accounts receivable to support monthly cash targets and overall revenue cycle goals.
• Analyzes the various methodologies for reimbursement and their contractual impact across the organization.
• Works with Finance and Accounting on issues between sub-ledger and G/L.
• In collaboration with Revenue Integrity, manages the charge master and pricing structure.
• Provide leadership and guidance to address coding and charge capture nuances.
• Collaborate with ICD-10 implementation team to ensure smooth transition.
• Oversee appropriate business applications in GE Centricity/IDX/IDX BAR/SDK/Epic systems.
• Actively participate in system upgrades and enhancements.
• Serve as a resource for department managers, physicians and administration to obtain information and clarification on accurate and ethical billing standards.
• Assist Patient Financial Services and FPF billing vendors with possible resolution and remediation efforts of billing edits.
• Oversee research of billing and coding requirements when new procedures and / or supplies are introduced.
• Monitor regulatory environment and implement appropriate workflow and process changes.
• Oversees and communicates education and training with providers and department(s) as necessary.
• Collaborate with administrative and clinical departments and Faculty Chiefs to identify opportunities to redesign processes.
• Develop and monitor metrics to ensure functions of the revenue integrity team are performed efficiently.
• Track, monitor and report trends of second level clinical appeals to Senior Management.

Requirements

• Bachelor's Degree in Finance, Financial Management, Finance Administration, Nursing or Information System Management.
• Minimum of 10 years of experience in health care management, related field or equivalent experience in hospital revenue cycle operations.

Nice-to-haves

• Master's degree.