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This position is responsible for the enterprise-wide coordination, planning optimization and performance of hospital, clinic, post-acute and professional Revenue Cycle activities. The leader is responsible for proactively driving Revenue Cycle activities and optimization strategies as well as leading the integration of Revenue Cycle activities across the health system. This position is accountable for 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 track record in team building.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor in Accounting, Finance, Business or a related field required
EXPERIENCE:
1. 10 years of related, progressive experience in patient access, health information management, managed care, patient accounting and/or revenue integrity required. 5 years must be hospital specific experience.
2. 5 years of prior management experience require
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Master's degree, MBA or CPA preferred
EXPERIENCE:
1. Experience with multiple patient accounting and information system applications. Epic experience preferred.
2.Demonstrated leadership experience and a proven track 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
3.Experience developing standards, processes, policies, procedures and service level agreements
4. 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
5. In-depth experience using and implementing/converting computerized patient accounting systems (Epic preferred)
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Responsible for planning, directing and coordinating hospital and professional Revenue Cycle activities including patient access (registration, pre-registration, pre-certification, financial counseling, etc.), utilization review and patient financial services (billing, collections, contract management, denials, etc.) ensuring the quality, timeliness, confidentially and efficiency of the Revenue Cycle process within the WVU Medicine enterprise.
2. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized.
3. Uses tools and metrics to support building a high performance team culture within the Revenue Cycle. Achieves measurable performance improvements in each Revenue Cycle function by developing and monitoring a suite of Revenue Cycle metrics and intervening on unfavorable trends.
4. Makes decisions in fast-paced, fluid environment where limited precedents exist; actively collaborates with key business and functional partners, such as facility CFOs, ambulatory administrators, physicians and operational leaders accurately and in a timely manner.
5. Utilizes team-building concepts to facilitate communication and direction that supports the system's mission, vision and values.
6. Provides leadership to all aspects of patient access, utilization review and patient financial services and works in collaboration with health information management, quality, clinical operations, compliance and senior management to ensure the best possible compliance, collection and customer service performance for all aspects of accounts billed by the organization.
7. Acts as primary contact point for the WVU Medicine EPIC transition for the EPIC HB, PB and ADT modules. Make critical operational decisions for multiple Revenue Cycle sites to create the streamlined processes needed for the EPIC transition project.
8.Sets strategy and provides superior knowledge of business processes and enabling technologies, specifically in billing and access functions. Is responsible for leading the development, implementation, and enforcement of Revenue Cycle policies and practices for the WVU Medicine enterprise.
9. Serves as a reference and coach to others (outside of Revenue Cycle) on key process, policies, and procedures.
10. Communicates ideas both verbally and written to influence others using one-on-one contact, formal presentations, and group discussions.
11. Primarily accountable for Revenue Cycle performance to WVUHS CFO, Hospital CFOs, physician and ambulatory leadership, system and entity boards of directors and other internal clients.
12. Defines and implements vendor strategy by cultivating and actively managing strong Revenue Cycle external contracts/relationships, performance and service levels.
13. Oversees the financial assistance, financial clearance, and collection guidelines as well as the allocation of write-offs, related controls, and the procedures and tactics to maintain optimal levels of bad debt and charity and to comply with all local and federal collection regulations.
14. 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 Cycle management. Constantly reviews and evaluates the effectiveness and efficiency of Revenue Cycle operations and recommends and guides modifications as conditions change.
15. Modifies processes with the patient in mind, continuously striving to improve the patient experience as it relates to patient access and patient financial services functions.
16. Explores, coordinates and integrates business development opportunities external to the WVU Medicine enterprise. Establishes, tracks, and reports key metrics for project success to external clients. Maintains a service-oriented perspective to meet external client needs.
17. Responsible for the post-acute Revenue Cycle including home health, hospice, skilled nursing, and acute rehab.
18. Ensures compliance with existing and new regulations related to the Revenue Cycle. Proactively researches regulatory changes and coordinates with key stakeholders to ensure timely and accurate compliance.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Office work which includes sitting for extended periods of time
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Office work which includes sitting for extended periods of time
2. Periodic travel throughout the region will be required
SKILLS AND ABILITIES:
1. 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
2. A comprehensive knowledge of hospital and physician reimbursement systems (DRG case rates, Medicare's OPPS, managed care reimbursement, West Virginia Medicaid reimbursement, RBRVS)
3. 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
4. Knowledge of and experience with current views on patient access functions including patient registration, pre-registration, pre-certification, and financial counseling
5. Knowledge of work standards and productivity measures, quality control mechanisms, and workload distribution
6. Aptitude to conceptualize, plan, and implement stated goals and objectives
7. Excellent understanding and experience with performance metrics
8. Demonstrated leadership skills and the ability to provide constructive feedback to team members to support continuous improvement
9. Strong collaboration, internal consulting, teambuilding, consensus building skills required
10. Ability to recognize the appropriate style, level of detail, and message for the audience
11. 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.
12. Ability to develop effective working relationships/ networks within and outside the organization
13. Computer skills, including spreadsheet, word processing, presentation, database applications (Microsoft suite preferred) and an awareness of applications relevant to Revenue Cycle
14. High-level problem identification/ mitigation/ resolution and analytical skills
15. Requires the ability to work with and maintain confidential information
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
WVUH West Virginia University Hospitals
Cost Center:
500 WVUH Administration
Address:
1 Medical Center Drive
Morgantown
West Virginia
This position is responsible for the enterprise-wide coordination, planning optimization and performance of hospital, clinic, post-acute and professional Revenue Cycle activities. The leader is responsible for proactively driving Revenue Cycle activities and optimization strategies as well as leading the integration of Revenue Cycle activities across the health system. This position is accountable for 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 track record in team building.
MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Bachelor in Accounting, Finance, Business or a related field required
EXPERIENCE:
1. 10 years of related, progressive experience in patient access, health information management, managed care, patient accounting and/or revenue integrity required. 5 years must be hospital specific experience.
2. 5 years of prior management experience require
PREFERRED QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. Master's degree, MBA or CPA preferred
EXPERIENCE:
1. Experience with multiple patient accounting and information system applications. Epic experience preferred.
2.Demonstrated leadership experience and a proven track 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
3.Experience developing standards, processes, policies, procedures and service level agreements
4. 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
5. In-depth experience using and implementing/converting computerized patient accounting systems (Epic preferred)
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.
1. Responsible for planning, directing and coordinating hospital and professional Revenue Cycle activities including patient access (registration, pre-registration, pre-certification, financial counseling, etc.), utilization review and patient financial services (billing, collections, contract management, denials, etc.) ensuring the quality, timeliness, confidentially and efficiency of the Revenue Cycle process within the WVU Medicine enterprise.
2. Helps foster an environment in which continuous improvement in business processes and services is welcomed and recognized.
3. Uses tools and metrics to support building a high performance team culture within the Revenue Cycle. Achieves measurable performance improvements in each Revenue Cycle function by developing and monitoring a suite of Revenue Cycle metrics and intervening on unfavorable trends.
4. Makes decisions in fast-paced, fluid environment where limited precedents exist; actively collaborates with key business and functional partners, such as facility CFOs, ambulatory administrators, physicians and operational leaders accurately and in a timely manner.
5. Utilizes team-building concepts to facilitate communication and direction that supports the system's mission, vision and values.
6. Provides leadership to all aspects of patient access, utilization review and patient financial services and works in collaboration with health information management, quality, clinical operations, compliance and senior management to ensure the best possible compliance, collection and customer service performance for all aspects of accounts billed by the organization.
7. Acts as primary contact point for the WVU Medicine EPIC transition for the EPIC HB, PB and ADT modules. Make critical operational decisions for multiple Revenue Cycle sites to create the streamlined processes needed for the EPIC transition project.
8.Sets strategy and provides superior knowledge of business processes and enabling technologies, specifically in billing and access functions. Is responsible for leading the development, implementation, and enforcement of Revenue Cycle policies and practices for the WVU Medicine enterprise.
9. Serves as a reference and coach to others (outside of Revenue Cycle) on key process, policies, and procedures.
10. Communicates ideas both verbally and written to influence others using one-on-one contact, formal presentations, and group discussions.
11. Primarily accountable for Revenue Cycle performance to WVUHS CFO, Hospital CFOs, physician and ambulatory leadership, system and entity boards of directors and other internal clients.
12. Defines and implements vendor strategy by cultivating and actively managing strong Revenue Cycle external contracts/relationships, performance and service levels.
13. Oversees the financial assistance, financial clearance, and collection guidelines as well as the allocation of write-offs, related controls, and the procedures and tactics to maintain optimal levels of bad debt and charity and to comply with all local and federal collection regulations.
14. 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 Cycle management. Constantly reviews and evaluates the effectiveness and efficiency of Revenue Cycle operations and recommends and guides modifications as conditions change.
15. Modifies processes with the patient in mind, continuously striving to improve the patient experience as it relates to patient access and patient financial services functions.
16. Explores, coordinates and integrates business development opportunities external to the WVU Medicine enterprise. Establishes, tracks, and reports key metrics for project success to external clients. Maintains a service-oriented perspective to meet external client needs.
17. Responsible for the post-acute Revenue Cycle including home health, hospice, skilled nursing, and acute rehab.
18. Ensures compliance with existing and new regulations related to the Revenue Cycle. Proactively researches regulatory changes and coordinates with key stakeholders to ensure timely and accurate compliance.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Office work which includes sitting for extended periods of time
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
1. Office work which includes sitting for extended periods of time
2. Periodic travel throughout the region will be required
SKILLS AND ABILITIES:
1. 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
2. A comprehensive knowledge of hospital and physician reimbursement systems (DRG case rates, Medicare's OPPS, managed care reimbursement, West Virginia Medicaid reimbursement, RBRVS)
3. 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
4. Knowledge of and experience with current views on patient access functions including patient registration, pre-registration, pre-certification, and financial counseling
5. Knowledge of work standards and productivity measures, quality control mechanisms, and workload distribution
6. Aptitude to conceptualize, plan, and implement stated goals and objectives
7. Excellent understanding and experience with performance metrics
8. Demonstrated leadership skills and the ability to provide constructive feedback to team members to support continuous improvement
9. Strong collaboration, internal consulting, teambuilding, consensus building skills required
10. Ability to recognize the appropriate style, level of detail, and message for the audience
11. 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.
12. Ability to develop effective working relationships/ networks within and outside the organization
13. Computer skills, including spreadsheet, word processing, presentation, database applications (Microsoft suite preferred) and an awareness of applications relevant to Revenue Cycle
14. High-level problem identification/ mitigation/ resolution and analytical skills
15. Requires the ability to work with and maintain confidential information
Additional Job Description:
Scheduled Weekly Hours:
40
Shift:
Exempt/Non-Exempt:
United States of America (Exempt)
Company:
WVUH West Virginia University Hospitals
Cost Center:
500 WVUH Administration
Address:
1 Medical Center Drive
Morgantown
West Virginia
