Executive Director - Revenue Cycle - Full Time

This position is accountable to monitor PMHA management of hospital registration, financial counseling, pre-certification, financial clearance, utilization review, billing, follow up, denials, contract management, customer service and vendor management in accordance with company policies and in compliance with federal and state billing regulations. This position will drive transformation of Revenue Cycle through teamwork, metric monitoring, technology, and standardization.
Successful candidates will be healthcare professionals with a successful record in leading a high volume, results-oriented Revenue Cycle division for a large, complex healthcare organization and a record in team building.
Responsible for the both the front-end (scheduling, pre-admission, registration) and back-end (billing and collections) Revenue Cycle functions across the PMCN system. Collaborates with PMHA to continually improve business and clinical processes (as appropriate) inclusive of internal personnel and external vendor support for these areas.
KEY DUTIES AND RESPONSIBILITIES:

• Specific to front-end Revenue Cycle - Oversees the corporate team providing direction to facility scheduling, pre-admission, and registration processes. This includes business decisions about IT system configuration, process, and procedures for insurance verification and related PMCN personnel and external vendor support. Engages with facility leaders to ensure process standardization and consist high-performance of metrics and KPIs. The Vice President will also make decisions related to investments and changes in net revenue enhancement tactics, software applications, outsourcing vendors, recovery projects, and other interventions to collect the net revenue associated with patient services delivered.
• Develops, leads, and improves Revenue Cycle workforce, processes, policies and procedures, and technologies to ensure they are developing, building, and complying with a clearly defined, effective revenue management approach consistent with the overall mission and strategic plan of PMCN.
• Oversees the management and continuous improvement of the operational standards to positively impact the overall collection, financial yield, cost of collection, accounts receivable days, and the service experience throughout PMCN. Leads and or coordinates efforts to reduce denials, eliminate waste, and improve service experience.
• Creates, chairs, and facilitates assigned Financial/Revenue Cycle Committees and other taskforces, such as, Financial Assistance/Charity Policy Committee, Denials Audit Strategy ("RAC") Council. Works closely with other Finance leaders across the organization to address local and system-wide Revenue Cycle opportunities.
• Oversees Financial Assistance (Charity), Financial Clearance, and Collection policies as well as the allocation of write-offs, related controls, and the procedures and tactics to maintain optimal levels of bad debt and charity.
• Provides regular reports to the Chief Financial Officer, and members of the Executive Leadership Team, in written and presentation formats. Acts as a single point of accountability for PMCN's Revenue Cycle performance and improvement opportunities.
• Monitors and measures the quantitative performance of each function within the Revenue Cycle, addressing unfavorable trends and areas of risks. Develops a relevant performance reporting suite of KPI metrics, and related structure of performance review meetings to establish an accountable environment.
• Researches, develops, and applies proven financial, workforce, and process management principles and methods to optimize the Revenue Cycle. Monitors the local and national emerging and best practices associated with Revenue Management. Reviews and evaluates the effectiveness and efficiency of Revenue Cycle operations and recommends and guides modifications as conditions change.
• Enhances the patient and physician service delivery aspects of the Revenue Cycle, including monitoring patient satisfaction survey data and other data points to refine the procedures which impact the delivery of service and customer satisfaction. Works with leaders on issues and improvement opportunities for brand, growth, and margin improvement.
• Completes or contributes to the completion of various financial forecasts and plans, including annual budgets, annual capital needs, month-end financial reporting, receivables levels (days in AR and aging), cost center productivity, and input to long-range strategic plans.
• Monitors Revenue Cycle external contracts/relationships, including PMHA performance and service levels, including functions outsourced, core and bolt-on technologies, specialty recovery vendors and collection agencies.
• Ensures internal control oversight and compliance with laws and regulations, safeguarding of assets, compliance with PMCN policies and procedures, reliability of internal and external reporting, and efficiency and effectiveness of operations. Creates an effective control environment, conducts risk assessment, implements, and monitors controls.

• Specific to back-end Revenue Cycle - Monitors PMHA performance to ensure success in achieving PMCN Revenue Cycle KPI's. Review key processes: such as contract build, CDM management, revenue integrity, claims edits, billing, payment posting, variance management, denial management, self-pay follow-up, bad debt, and Payer Escalation (action after final denials). Also manages the analytics team that supports data management and dashboard reporting for daily, weekly, monthly, and annual reporting cycles.
• Ensures compliance with professional, state, and federal regulatory requirements.
• Oversees 1.00 FTE Senior Financial Analyst.

Requirements: Core Qualifications
Education:

• Bachelors in Accounting, Finance, Business, or a related field required.
• Master's Degree in relevant field, preferred.

Knowledge, Skills, and Attitudes:

• Billing and Collections experience required.
• Cerner and Meditech Experience required.
• Strong negotiator
• Advanced proficiency in computer software (i.e., Microsoft Office)
• Ability to communicate effectively in both oral and written form.
• Ability to recognize, analyze and solve a variety of problems.
• Ability to manage a budget and work within the constraints of that budget.
• Ability to direct, manage, implement, and evaluate department operations.

EXPERIENCE:

• Minimum of 5 - 8 years of relevant experience
• Experience with multiple patient accounting and EMR information system applications. Cerner and Meditech experience required.
• Demonstrated leadership experience and a proven record in Revenue Cycle management in a facility and/or multi-facility system of significant size and complexity, hospital and professional business operations, information systems, and patient accounting applications.
• Experience developing standards, processes, policies, procedures, and service level agreements.
• Experience in budget preparation and planning, development and monitoring of staff productivity systems analysis and tracking, quality improvement and establishment of quality standards and monitors and the implementation of other key management control systems
• In-depth experience using and implementing/converting computerized patient accounting systems (Cerner and Meditech required)
• Progressive experience in patient access, health information management, managed care, patient accounting and/or revenue integrity required. 5 years must be hospital and Physician practice specific management experience.
• The following seemed like a continuation of duties rather than experience required for the job.

SKILLS AND ABILITIES:

• A comprehensive knowledge of patient financial services functions including registration, utilization review, claims submission, billing, follow up, cash management, vendor relations, regulatory and compliance filings, payment variance, denial management, patient financial engagement, and payer relations functions.
• A comprehensive knowledge of hospital and physician reimbursement systems (DRG case rates, Medicare's OPPS, managed care reimbursement, Pennsylvania Medicaid reimbursement, RBRVS).
• Knowledge of current nationwide trends in patient collections and the patient's financial experience, including self-pay estimation, payment plans, 501r compliance, and bad debt collections.
• Knowledge of and experience with current views on patient access functions including patient registration, pre-registration, pre-certification, and financial counseling.
• Knowledge of work standards and productivity measures, quality control mechanisms, and workload distribution.
• Aptitude to conceptualize, plan, and implement stated goals and objectives.
• Exceptional understanding and experience with performance metrics.
• Demonstrated leadership skills and the ability to provide constructive feedback to team members to support continuous improvement.
• Strong collaboration, internal consulting, teambuilding, consensus building skills required.
• Ability to recognize the appropriate style, level of detail, and message for the audience.
• Effective internal consulting skills along with the ability to positively influence others in a desired direction to achieve identified outcomes without direct lines of authority.
• Ability to develop effective working relationships/ networks within and outside the organization.
• Computer skills, including spreadsheet, word processing, presentation, database applications (Microsoft suite preferred) and an awareness of applications relevant to Revenue Cycle.
• High-level problem identification/ mitigation/ resolution and analytical skills.
• Requires the ability to work with and maintain confidential information.

WORK LOCATION: 640 Kolter Building, Indiana Pennsylvania. Hybrid position: Partial remote work.