Location
Douglasville, GA | United States
Job description
Overview The Director of Revenue Cycle Operations (DRCO) is responsible for overseeing the accounts receivable and revenue cycle operations at one of the hospitals within the WellStar Health System. The DRCO has 7 main responsibilities: team leadership, revenue cycle operation duties as assigned, financial, reimbursement, denials & adjustments, resource for hospital leadership where necessary and operational and reporting responsibilities when assigned. The following is a comprehensive but not exhaustive list of responsibilities. Along with the each of these responsibilities is outlined below, other duties may be assigned as needed based on operational and business needs:
Work with financial leaders in the facility to complete the month end revenue cycle performance including, but not limited, to the following:
Regularly review operational revenue cycle performance based on a set of defined key performance indicators against targets
Review large dollar financial class changes that affect reserves and accurate statement of monthly net revenue
Collaborates with the CFO to explain net revenue variances for the month end.
Work with key stakeholders to determine root cause of variances related to CFB, cash, AR and denials
Team Leadership duties:
Conduct revenue cycle meetings as needed and follow up with vendors (AR related, TPL, Coverage Eligibility) regarding deliverables.
Conduct and drive monthly Denial meetings to help determine root cause and improve processes to reduce denials to benchmark targets.
Regular Operational and Reporting Duties:
Assess, review daily work queues, which include the following: Charge, CFB, Adjustments, etc to ensure accounts are being worked timely
Provide oversight and direction of the daily report requests. Reports are as follows: DNFB, CFB trending, AR reports, and other reports as requested
Facility revenue cycle contact for Case Coordination/Utilization Management.
Liaison and point of escalation for revenue cycle customer service requests and issues.
Monitor and assist with CFB resolution as it relates to revenue cycle.
Interface with AR, PAS, SBO as needed regarding the following key metrics:
Total cash collections
POS cash
Denial write offs
Medicaid outliers
Payor trends
Specific accounts reviews
Special account handling that may be needed.
Assists various business units with general facility-based inquiries thus improving claims quality and overall cash performance.
Works with facility departments to resolve various revenue cycle issues, (order clarification, patient status changes, account charging, etc.).
Coordinates annual Trauma Uncompensated Care Audit
Consistently communicate with Revenue Cycle departments (PAS, AR, SBO), vendors and their staffs to ensure ongoing issues are resolved in a timely manner.
Denials & Fatal Adjustments
Analyze, report, and facilitate monthly meetings related to payor denial trends including the following:
Monthly trends
A3 Focus (WHS) related to denials
Review and process improvement initiatives with key stakeholders and develop SBAR
Fatal Denial write off analysis
Hospital Leadership Activities:
Participant in the following facility meetings:
Department Directors
Denial/Disputes
Utilization Management (present denials and disputes)
Complex Case Meeting with CM weekly to discuss specific patients
Promotes and contributes positively to interdepartmental relationships.
Provide positive leadership for the department that promotes an environment of cooperation and learning.
Maintain effective communication with other Patient Financial Services and Revenue Cycle departments
Evaluate best practices suggestions for possible implementation into the revenue cycle processes.
The DRCO may perform complex data analysis and make independent decisions within the scope of responsibility through a shared vision driven by the Assistant Vice President of Revenue Cycle Operations, the Vice President of Revenue Cycle, and other senior leadership. The DRCO interacts with executives, other directors, and all members of the Revenue Cycle within WellStar Health System, including leaders of health information management, corporate compliance, accounting and medical group revenue cycle. External contacts may consist of patients and their families, insurance companies, state and federal agencies, auditors, and vendors. This position reports to the Assistant Vice President of Revenue Cycle Operations.
Preferred Leadership Competencies for This Role:
Drive: Capacity to channel energy to achieve personal and professional goals with a focus on continual innovation and improvement.
Intellectual Acumen: Strong desire to continually search for new information and the ability to adapt to new situations. Desire for continuous learning and has the ability to think in a multi-faceted way to achieve results.
Relationships: Ability to establish and develop relationships and understand the value of effective communication. Courage to seek and ask the right questions and to recognize and understand the importance of listening and building trust.
Focus: Ability to work in a fast-paced environment that requires results. Ability to accept, adapt, and drive continuous improvement, change, and innovation. Makes decisions using filters such as:
1. Quality and Safety
2. Compassionate Care
3. Memorable Experiences
4. Efficiency and entrepreneurship
Individualized Approach: Recognizes that each person is unique and seeks to know individuals and their uniqueness.
Response to Negativity: Ability to replace negativity with positive suggestions and discuss negative situations in private (one-on-one) and never before a group. Understands the importance of being positive when building teams.
Executive Skill: Participates in the creation of goals and a vision. Capacity to lead and persuade others to accept established goals and values. Selects the right talent to ensure the success of the organization.
Creates an environment of continual process improvement responsive to the needs of the customer.
Expected Performance, Behaviors and Results:
The 'WellStar Experience': (Must demonstrate a commitment to Service Excellence by):
Creating first impressions, memorable moments and impressions that fulfill the expressed and unexpressed wishes and needs of patients and family members.
Valuing patients and family members as partners in their care.
Having world-class processes in place.
Delivering high-touch care that is reliable, responsive and coordinated.
Focusing on constant innovation and creating improvements.
Celebrating our diversity with sensitivity and understanding.
Embracing the idea that we are all owners of our health system
Responsibilities Core Responsibilites and Essential Functions
- Job Functions
* Execute operational duties where responsible (ie, workqueues, reporting, MOR duties)
* Maintain a strong knowledge of insurance billing and reimbursement procedures and federal, state, and local regulations related to insurance billing and collections.
* Ensure that all Revenue Cycle activities, are conducted in compliance with all state and federal regulations
* Enforce the adherence to Revenue Cycle and system written policies, procedures, and processes where necessary.
* Work closely with the WellStar Connect team to ensure an effective implementation of new billing systems, identify opportunities for system or process improvements with WellStar Connect and beyond, and drive change through targeted initiatives.
* Report and review key metrics and progress on outstanding initiatives with the Assistant Vice President of Revenue Cycle Opeartions on a regular basis.
* Identify opportunities for hospital or process improvements and drive change through targeted initiatives.
* Facilitate regular staff meetings to communicate departmental and organizational issues, goals, achievements, and changes.
* Responsible for assisting with the effective budget development and financial performance of the department as delegated in the areas of salary expense, supply expense, and capital needs and expenditures.
* Demonstrate excellent customer service through oral and written communication in providing assistance/expertise to patients, families, and other external or internal contacts.
* Proficiently use all systems and processes applicable to the job.
* Serve as role model and mentor to co-workers
* Perform other duties and responsibilities as assigned - Professional Communication
* Maintain confidentiality in matters relating to patient/family.
* Interact with patients/families with a variety of developmental and sociocultural backgrounds.
* Provide information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity, and caring.
* Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies.
* Initiate communication with peers about changes and procedures.
* Relay information appropriately over telephone, email, and other communication devices. - Teamwork
* Accept assignments based on needs and the qualifications and competencies of self and of other staff members.
* Work closely with other staff, co-workers, peers, and other members of the healthcare team to ensure a positive and effective work environment.
* Delegate work to other staff members as needed.
* Report to appropriate personnel regarding assignments, projects, etc.
* Initiate problem solving and conflict resolution skills to foster effective work relationships with peers.
* Report to work on time and as scheduled. - Professional Development
* Attend staff meetings, in-services, and continuing education.
* Contribute to annual reviews of peer performance as requested by the unit/area supervisor or manager.
* Assist in the development of indicators, thresholds, study methods, and data collection as assigned.
* Respond to problems/opportunities to improve care/customer service.
* Support involvement in system performance improvement initiative.
* Participate in and maintain competencies required for the position and specific unit/area(s) of assignment.
Required for All Jobs
- Performs other duties as assigned
- Complies with all WellStar Health System policies, standards of work, and code of conduct.
Qualifications Required Minimum Education
- Bachelor's Degree Required
Required Minimum Experience
- Minimum 7 years to ten (10) years hospital revenue cycle experience Required and
- Minimum 3 years of progressive leadership in a complex healthcare organization Required and
- Exceptional interpersonal skills for written, verbal, presentation, and computer communication Required
Required Minimum Skills
- Knowledge of state and federal regulations as they pertain to billing processes and procedures.
- Knowledge of insurance claim processing and third-party reimbursement.
- Knowledge and detailed understanding of all negotiated agreements.
- Knowledge of the principles of Information Systems in order to effectively analyze and make decisions.
- Skill in good oral, written, and interpersonal communication.
- Skill in problem solving in a variety of settings.
- Skill in technical or professional accounting.
- Skill in time management and project management.
- Ability to work efficiently under pressure.
- Ability to operate a computer and related applications. Advanced proficiency in Microsoft Excel.
- Ability to apply appropriate supervisory, management and leadership techniques in an operational setting.
- Ability to work independently and take initiative.
- Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
- Ability to deal effectively with constant changes and be a change agent.
- Ability to deal effectively with difficult people and/or difficult situations.
- Ability to willingly accept responsibility and/or delegate responsibility.
- Ability to set priorities and use good judgment for self and staff.
Required Minimum License(s) and Certification(s)
Additional Licenses and Certifications
We’d like to invite you on a career journey like no other! In return for your contributions, we’ll help you make the most of all life’s moments – on and off the job. Wellstar Total Rewards is designed to provide for your total well-being, including: Your Wellness, Your Pay, Your Future, Your Joy. We think it’s pretty simple – we care for our team members and our team members care for the community.
Make a difference in patients’ lives… and your own! Here, it’s more than healthcare – it’s CareerCare!
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