Dir, Claims Follow-up

Job Description

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

The Director of Revenue Cycle is responsible for the oversight of all follow-up activity related to professional and hospital services and payer sources. Monitors accounts to effectively reduce outstanding account receivables and improve cash flow and provides linkage to other department personnel to correct and resubmit billing, and if necessary, Makes recommendations to leadership to write-off account balances deemed uncollectable to ensure the ability to successfully bill and collect for services rendered.

The Director will have in-depth knowledge of governmental and commercial insurance rules and regulations, including regulatory compliance requirements applicable to hospital and physician group revenue cycle that has both provider-based and physician office site of service components. The Director is accountable for ensuring the coordination of follow up and collections throughout the organization.

Responsibilities

1. Providing the analysis, reporting, recommendations and implementing strategic action plans for revenue cycle services performance in key metrics related to collections and accounts receivable management, such as volumes, collection ratios, A/R aging, and related trends.

2. Performs regular accounts receivable aging reviews with billing team to monitor balances that are approaching unacceptable time frames or dollar amounts.

3. Reviews claims for collectability, recommends claims for write-off, and calculates the Allowance for Bad Debt on a monthly basis.

4. Monitor and manage accounts receivable, ensuring timely follow-up on unpaid claims and reducing A/R aging.

5. Works closely with key stakeholders in operations including admissions, clinical operations and HIM to ensure efficient operations and streamline revenue cycle processes.

6. Reports key Performance Indicators (KPIs) on a monthly basis. Continuously monitors the regulatory environments to ensure that payors evolving reimbursement structures, documentation requirements, and other requirements are evaluated and necessary changes in policies and procedures (and systems) are completed.

7. Initiates development of new approaches to streamline existing processes, reorganize work, implement new technologies, and improve resource utilization as RCM links to the organization.

8. Recruits, trains, and mentors team members to cultivate high performance. Ensures cross-training and backup for each significant payer and critical tasks.

9. Maintains a working knowledge of all revenue cycle management computer systems; works with internal IT staff and external software vendor to stay current with changes in technology; ensures all payer information is set up correctly.

10. Work with IT and other departments to implement automation tools that enhance RCM processes and reduce manual workloads.

11. Maintain relationships with insurance payers including dispute resolution.

12. Maintains department policies and procedures as accurate descriptions of current work practice.

13. Works with EBO Vendors to ensure quality and productivity standards are met.

14. Maintain continual knowledge of payor policies to assure optimal reimbursement for all services performed within the system, in compliance with government and third-party payor regulations.

15. Directs employees to meet the organizations expectations for productivity, quality, and goal accomplishment.

16. Serves as a knowledgeable resource in resolving insurance claim processing issues.

17. Monitors changes in the medical insurance industry and adjusts procedures accordingly.

18. Oversee the review and evaluation of third-party claim policies and procedures for insurance plans and assist in developing new procedures to improve the quality and quantity of work processed.

19. Assist in troubleshooting problematic accounts, identify trends, and root causes, and lead internal and interdepartmental initiatives to resolve issues.

20. Participate in provider and third-party vendor conference calls regarding billing/reimbursement issues and trends, as well as Contract Interpretation and Joint Operating Committee meetings.


Skill Set Requirement:

Strong knowledge of healthcare billing, coding practices, reimbursement methodologies and revenue cycle.

Excellent written and verbal communication skills. (exceptional communication, interpersonal, listening, coaching, facilitation and conflict resolutions skills)

Strong leadership and management abilities.

Leadership experience in managing teams across multiple sites with a healthcare focus.

Analytical thinking and problem-solving skills.

Attention to detail and ability to manage multiple priorities.

Very strong strategic, vision and process change improvement leader.

Advanced proficiency in accounts receivable management.

Strong analytical, problem solving, root cause analysis skills to evaluate problems and interpret trends.

Demonstrated process improvement, project management, workflow, benchmarking and evaluation of business processes required.

Strong computer skills including using Microsoft products like Excel, word, PowerPoint, outlook, one drive.

Comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding

Third-party payer procedures practices and contracts.

Governmental legal and regulatory provisions related to claims resolution activities.

Skill in establishing and maintaining effective working relationships with other employees, patients, physicians, insurance organizations, and the public.

Requires a strong hands-on leader with the ability to prioritize, plan, and manage the Hospital, and Professional Claims Follow-up Department.

Minimum Requirements

Required Education/Course(s)/Training:

Bachelor's degree or equivalent education and/or 10+ years of experience in professional and hospital revenue cycle account receivable management
8+ years of professional and hospital directly related management/leadership experience.

Preferred Education:

Master's degree and/or 15+ years related work experience.

Required Certification/Registration: None

Performance Expectations:

Successful achievement of the following:

Proven ability to lead and motivate teams to achieve high performance.

Strong financial acumen with experience in accounts receivable management, revenue optimization, and forecasting.

Must be able to work independently and efficiently with little supervision.

Must have a strong desire to teach / transfer knowledge to team members.

Ability to recognize, evaluate, solve problems, and correct errors including complex claims processing issues.

Must demonstrate ability to work in fast-paced, deadline-oriented environment where the ability to meet deadlines is a must with constant communication required.

Demonstrates leadership and group cohesive skills that promote teamwork and group achievement.

Exhibit strong relationship management skills and the capability to navigate challenging interpersonal situations effectively.

Show proficiency in building and maintaining strong internal relationships while motivating and inspiring team members through effective consultative skills.

Ability to identify and implement process improvements to optimize revenue cycle performance.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.