Director of Patient Financial Services Portland, OR
The purpose of this position is to achieve a level of high performance in billing for both hospital & professional services through directing & managing the entire billing process. This includes data charge entry, hospital/professional billing, cash posting, collections, medical financial assistance, & billing customer service. This role requires expertise in fee for service patient billing & collections around all aspects of the revenue cycle, & the development of supporting policies & procedures. The position must maintain full compliance with increasingly complex external fraud & abuse & other regulatory & legal risks associated with patient billing & collections. This role is a key member of the Revenue Cycle team, with involvement in decisions affecting all areas of the revenue cycle will be required.
Essential Functions:
- Develop & maintain billing controls within Patient Financial Services (PFS)
- Manage & develop a high functioning patient billing & collection team that includes manager & supervisor levels that support delegation & oversight
- Continually assess & develop an organizational structure that supports high performance results during significant system & insurance product changes
- Work in partnership with labor to ensure that the contract in place is monitored & followed
- Identify performance indicators & benchmarks & integrate with reporting
- Utilize appropriate software reporting tools
- Develop appropriate reporting for various levels of management
- Develop & maintain departmental policies & procedures
- Develop staff that can analyze & recommend ongoing improvements to processes, procedures, systems & reports (management, operations & transactions)
- Direct & manage accounts receivable (A/R) to ensure accounts are collected appropriately from members, nonmembers, insurance carriers, Medicare, Medicaid, & other payer sources
- Plan, coordinate & prepare information for quarterly & year-end audits with public accounting firms & third-party auditors as they relate to A/R operations
- Direct the processing of cash receipts collected from members, accounts receivable lockboxes, & insurance payments; ensure that cash is accurate & balances on a daily basis
- Develop systems & controls to ensure that cash management includes appropriate internal controls
- Maintain & follow guidelines of the Sarbanes Oxley requirements; ensure that required audits are completed on a timely basis, & issues identified are researched & addressed on an ongoing basis
- Support ongoing work with community benefit & charity care, & ad-hoc business case analyses
- Counsel staff, develop high performers & take appropriate action with poor performers including highly structured & formalized progress disciplinary steps when required
- Recruit, develop & maintain competent & productive management team members
- Responsible for staff development & related goal setting/performance standards with PFS managers & staff
- Delegate authority to unit managers for management of day-to-day operations & the completion of special projects
- Other duties may be required
Qualifications:
Basic Qualifications:
- A minimum of 8 years of progressive hospital patient accounting
- A minimum of 5 years of managing a large patient accounting department
- Bachelor's degree or equivalent combination of education and work experience
- High level of understanding of computer systems
- Extensive knowledge of State and Federal Laws related to health care billing and collection requirements
- High level of knowledge of governmental compliance rules and issues as it pertains to health care billing, collection and other reimbursement
- Detailed understanding of billing technical elements such as standard forms and data, coordination of benefit and third party liability billing and collection, electronic billing, data edit programs, reimbursement methodologies such as DRGs, APDRGs, APCs, ASCs
- Strong financial knowledge in AR and reserve analysis, basic market analysis; staffing and financial reporting skills
- Functional understanding of health care operations and physician group practices
- Excellent communication and negotiation skills
- Demonstrated skill and prior experience in writing reports and making presentations of complex materials to a variety of audiences
- Demonstrated leadership skills and ability to work independently. Ability to unify and motivate teams to accomplish goals and objectives
- Ability to resolve complex problems and influence acceptance and adherence to difficult policies, especially in team members that do not have a formal reporting relationship to this position
- Ability to analyze and resolve problems that affect the bill submission and collection process, regardless of whether the problem originates in an area under direct or indirect control
- Financial management skills, including the ability to financially analyze data for operations, budgeting, auditing, forecasting
Preferred Qualifications:
- Prior management of a union-represented staff
- Masters degree in Business, Finance or Accounting.
- Professional billing in a hospital/clinic setting
- Certification from HFMA or other related organization
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