Senior Director of Revenue Cycle - North Country Hospital

Statement of Purpose

The Senior Director of Revenue is responsible and accountable for planning, leadership and on-going continuous quality improvement or revenue cycle operations across the health system. This includes working with revenue integrity personnel to design, direct and execute key revenue integrity processes including monitoring third party contract compliance, charge description master (CDM), charge capture, charge audit, training/education and reconciliation initiatives. The Senior Director will work collaboratively with staff to monitor and maximize key performance metrics and implement new initiatives or requirements as arise.

Essential Functions, Duties and Responsibilities

Reports directly to the Chief Financial Officer.

Maintain appropriate internal controls over accounts receivable and cash receipt functions.

Provides guidance and supervision of PFS staff, billing office, and Credit & Collections, and Patient Registration departments through the establishment of goals for performance standards and monitoring of results. Holds regular staff meetings to achieve operating results consistent with department and hospital goals.

Interprets and evaluates the impact of the departments and the appropriate response or strategy of the departments to the problems, changing conditions, and issues that confront the departments on an ongoing basis.

Determines appropriate operational changes and coordinates procedural and systems changes as necessary.

Ensures that personnel policies are followed, and consistency is attained through meetings with management, participation in staff meetings, and review of evaluations and disciplinary documents.

Provides thorough follow-through and resolution of complaints or problems received from patients, staff, other departments, administration, or medical staff.

Oversees the renewal of maintenance, service, and support contracts for patient fiscal services.

Ensures that patients are served in a tactful, efficient manner.

Monitors reimbursement rates, legal terms, performance programs, and risk arrangements with third party payers to meet strategic objectives that maximize financial performance. Additionally, establishes government and contracted payer level monitoring of critical billing bulletins that will inform revenue cycle policy related to charge master structure, charge entry, coding, patient cost-sharing collections and billing to ensure optimized reimbursement and compliance.

Serves as primary contact and resource regarding contract interpretation, coding requirements, and other managed care reimbursement issues. Works with internal clients to resolve issues, recommends process improvement regarding reimbursement issues, and recommends future contract changes to enhance reimbursement and overall contract performance.

Creates and maintains organization-wide deployment, policies and procedures for compliant revenue charging activities for all areas of patient financial services. Works with internal clients to ensure appropriate charge capture for all services rendered.

Assesses and identifies services that are reimbursable but are not being coded; reviews, assigns, and validates revenue codes to insure proper billing in concert with PFS and Finance departments.

Oversees the monthly net revenue/accounts receivable valuation and analytics and development of volume based revenue budgets for both the hospital and physician practices. Prepares year end revenue related accounting entries and audit work papers. Responds to audit questions as appropriate.

Works with leadership on system strategy, tactics and issue resolution taskforces.

Provides timely performance evaluations for staff and maintains timesheets and time off for direct reports.

Participate in professional activities and maintain professional affiliations as appropriate.

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements which may be inherent in the position.

Working Conditions:

General office conditions.

Job Requirements

Minimum of 5 years of revenue cycle experience.

Strong analytic, time and project management skills

Extensive knowledge of laws and regulations pertaining to healthcare industry.

Experience in provider contracting in a hospital and/or health plan preferred.

Maintains confidentiality and assumes responsibility to carry out all assignments in a proficient and professional manner.

Ability to communicate (in written and oral form) effectively with a wide variety of individuals and groups.

Demonstrated ability to independently handle multiple unique, sensitive and complex matters with minimal supervision and oversight.

Orientation, ability, and presence to analyze complex situations and relationships in a manner which meets the needs of management.

Ability to relate to persons in a manner so as to gain support and promote confidence

PI256060525