Position Summary:

Plans, organizes, controls, standardizes and directs pre-billing and billing strategy, operations and revenue cycle management activities for UH. The role provides leadership, direction, decision making, and supports management and staff in day to day Billing, including corporate hospital, physician, and specialty. This Revenue Cycle Management (RCM) leadership role will work closely with all RCM departments and functions to coordinate support and hand offs between hospital and or physician departments and RCM teams to support compliant billing and optimize patient experience and collections. Additionally, this role will work directly with hospital and service line customers to help support services needed to optimize billing.

Routinely monitors, measures, shares and improves performance and metrics meet established goals. Sustains most up to date internal and external requirements to operate business unit in compliance with regulations and drives team and UH enterprise culturally as well as through formal initiatives supporting compliant billing through people, process and technology updates that help to centralize and standardize business processes within revenue cycle management as well as the organization.

Establishes, enforces and ensures standards of performance and behaviors, monitors and analyzes departmental service standards for hospital, physician & specialty Billing and service, reporting and account resolution.

The position is responsible for adhering and creating structures, policies, guidelines in coordination with RCM leaders, as well as driving business strategies, analysis, and outcomes to optimize billing resulting in expected payment. Ongoing alignment and strategy to coordinate and follow processes implemented by RCM.

Understands and supports internal and external relationships including I.T., Legal, Compliance, Internal Audit, Finance and Clinical Department Leadership as well as vendor relationships to ensure compliant revenue transactions for the business unit and associated departments and service lines.

Essential Duties:

• Directs department activities and ensures compliant services and operations including ensuring timely, accurate and customer friendly service including setting goals using industry benchmarks to drive best practice performance. Meets with leadership and staff weekly to ensure success department operations and help to resolve issues impeding performance.
• Implements and sustains routine auditing processes and reports findings as appropriate. Identifies billing errors, and follows-up with staff members/third party payers to ensure resolution reporting with feedback cycles are completed and documented to ensure ongoing improvement in service delivery.
• Develops, implements and publishes department score card capturing key performance indicators for each unit.
• Conducts analysis of department statistics to help identify and implement remediation plans.
• Actively manages technology and vendor performance, outcomes and relationship ensuring expected outcomes are met and /or real time decisions to ensure best practice performance.
• Accomplishes human resource objectives by leading recruiting, selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining leaders and employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures.
• Maintains free and unrestricted access to all UHPS and UH Hospitals functions, records, property and personnel relevant to the subject under review and provides advisory role and is the liaison to key areas such as: Compliance, Legal, and Internal Audit
• Develops and implements risk assessment tools to identify areas of potential liability related to professional and hospital medical record documentation practices, charge capture mechanisms, coding efforts and billing activities.
• Develops and implements clinician training programs where necessary in areas such as: medical visit and procedural documentation practices, and a control plan to sustain compliance required for billing.
• Assists to develop departmental compliance efforts. Ensures consistency between UHPS and UH Hospitals billing compliance efforts.
• Monitors billing practices and serves as UH Hospitals and UHPS representative for external billing audits and investigations including audits initiated by the Office of the Inspector General, Medicare Administrative Contractors, Recovery Audit Contractors, and private payers.
• Collaborates with the UHPS and UH Hospitals Revenue Cycle Management, and Corporate Compliance and Ethics on billing compliance issues.
• Develop and conduct annual reviews of claim scrubber edits to ensure compliant billing based on the most recent billing regulations. Ensure rules are updated in the claim scrubber based on coding updates and payer rule changes.
• In consultation with the Vice President of System Revenue Cycle, recommends modifications to overall billing compliance efforts to enhance effectiveness. Establishes goals and objectives for the department; develops policy and practices, procedures for compliance and auditing activities; directs and controls both the technical and administrative functions.
• Preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.
• Improves billing quality results by studying, evaluating, and re-designing processes; establishing and communicating service metrics; monitoring and analyzing results; implementing changes.
• Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Works with leadership team to establish staff assessment, training and post training validation programs and ensures adherence requirements, as well as providing staff the materials needed to empower them to work through claim edits as needed to ensure timely, compliant billing.
• Identifies opportunities for process improvement and automation by recognizing issues based on changes in patient inquiry trends. Provides timely feedback to peers in operational areas and leadership to improve Revenue cycle processes based on patient experiences. Participates in process improvement initiatives throughout the entire revenue cycle operation.
• Ensures that self and department remain current with governmental and third party payers and ensures in-depth knowledge of policies, procedures and laws relating to medical insurance/patient billing and collections.
• Acts as Revenue Cycle leader and liaison to organization and vendors that interact with patients.
• Performs remote leadership evaluations and ensures standardization with the staff evaluation process.
• Performs other duties as assigned.

Position Summary:

Plans, organizes, controls, standardizes and directs pre-billing and billing strategy, operations and revenue cycle management activities for UH. The role provides leadership, direction, decision making, and supports management and staff in day to day Billing, including corporate hospital, physician, and specialty. This Revenue Cycle Management (RCM) leadership role will work closely with all RCM departments and functions to coordinate support and hand offs between hospital and or physician departments and RCM teams to support compliant billing and optimize patient experience and collections. Additionally, this role will work directly with hospital and service line customers to help support services needed to optimize billing.

Routinely monitors, measures, shares and improves performance and metrics meet established goals. Sustains most up to date internal and external requirements to operate business unit in compliance with regulations and drives team and UH enterprise culturally as well as through formal initiatives supporting compliant billing through people, process and technology updates that help to centralize and standardize business processes within revenue cycle management as well as the organization.

Establishes, enforces and ensures standards of performance and behaviors, monitors and analyzes departmental service standards for hospital, physician & specialty Billing and service, reporting and account resolution.

The position is responsible for adhering and creating structures, policies, guidelines in coordination with RCM leaders, as well as driving business strategies, analysis, and outcomes to optimize billing resulting in expected payment. Ongoing alignment and strategy to coordinate and follow processes implemented by RCM.

Understands and supports internal and external relationships including I.T., Legal, Compliance, Internal Audit, Finance and Clinical Department Leadership as well as vendor relationships to ensure compliant revenue transactions for the business unit and associated departments and service lines.

Essential Duties:

• Directs department activities and ensures compliant services and operations including ensuring timely, accurate and customer friendly service including setting goals using industry benchmarks to drive best practice performance. Meets with leadership and staff weekly to ensure success department operations and help to resolve issues impeding performance.
• Implements and sustains routine auditing processes and reports findings as appropriate. Identifies billing errors, and follows-up with staff members/third party payers to ensure resolution reporting with feedback cycles are completed and documented to ensure ongoing improvement in service delivery.
• Develops, implements and publishes department score card capturing key performance indicators for each unit.
• Conducts analysis of department statistics to help identify and implement remediation plans.
• Actively manages technology and vendor performance, outcomes and relationship ensuring expected outcomes are met and /or real time decisions to ensure best practice performance.
• Accomplishes human resource objectives by leading recruiting, selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining leaders and employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures.
• Maintains free and unrestricted access to all UHPS and UH Hospitals functions, records, property and personnel relevant to the subject under review and provides advisory role and is the liaison to key areas such as: Compliance, Legal, and Internal Audit
• Develops and implements risk assessment tools to identify areas of potential liability related to professional and hospital medical record documentation practices, charge capture mechanisms, coding efforts and billing activities.
• Develops and implements clinician training programs where necessary in areas such as: medical visit and procedural documentation practices, and a control plan to sustain compliance required for billing.
• Assists to develop departmental compliance efforts. Ensures consistency between UHPS and UH Hospitals billing compliance efforts.
• Monitors billing practices and serves as UH Hospitals and UHPS representative for external billing audits and investigations including audits initiated by the Office of the Inspector General, Medicare Administrative Contractors, Recovery Audit Contractors, and private payers.
• Collaborates with the UHPS and UH Hospitals Revenue Cycle Management, and Corporate Compliance and Ethics on billing compliance issues.
• Develop and conduct annual reviews of claim scrubber edits to ensure compliant billing based on the most recent billing regulations. Ensure rules are updated in the claim scrubber based on coding updates and payer rule changes.
• In consultation with the Vice President of System Revenue Cycle, recommends modifications to overall billing compliance efforts to enhance effectiveness. Establishes goals and objectives for the department; develops policy and practices, procedures for compliance and auditing activities; directs and controls both the technical and administrative functions.
• Preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.
• Improves billing quality results by studying, evaluating, and re-designing processes; establishing and communicating service metrics; monitoring and analyzing results; implementing changes.
• Updates job knowledge by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
• Works with leadership team to establish staff assessment, training and post training validation programs and ensures adherence requirements, as well as providing staff the materials needed to empower them to work through claim edits as needed to ensure timely, compliant billing.
• Identifies opportunities for process improvement and automation by recognizing issues based on changes in patient inquiry trends. Provides timely feedback to peers in operational areas and leadership to improve Revenue cycle processes based on patient experiences. Participates in process improvement initiatives throughout the entire revenue cycle operation.
• Ensures that self and department remain current with governmental and third party payers and ensures in-depth knowledge of policies, procedures and laws relating to medical insurance/patient billing and collections.
• Acts as Revenue Cycle leader and liaison to organization and vendors that interact with patients.
• Performs remote leadership evaluations and ensures standardization with the staff evaluation process.
• Performs other duties as assigned.