Executive Director of Physician Rev Cycle
Location
Marietta, GA | United States
Job description
Overview The Executive Director of Accounts Receivables Medical Group Business Office (MGBO) manages all resources and activities related to managing the daily operations of Account Resolution, Payment Variance, Insurance Credits, Insurance Cash Applications and Hospice Revenue Cycle (End-to-End). This position provides leadership and direction for physician billing functions including researching and following-up on all outstanding insurance receivables. He/She is accountable for accelerating cash collections as it relates to account follow up. Identifying underpayments and appealing those variances directly with the payors or working with Managed Care to handle bulk appeals. Timely and accuratly posting of all insurance cash and refunds and insuring claims are billed timely and appropriately. This position is also responsible for all Hospice Revenue Cycle functions.
The WellStar Medical Group (WMG) is a multi-specialty group of approximately 1200 employed providers, covering over 80 specialties of service across over 300 locations. The Executive Director is responsible for developing and implementing sound policies and procedures across all offices to ensure adherence to federal/state regulations and uphold Wellstar's mission and values to promote high levels of patient satisfaction
This leader completes and/or directs complex data analysis and makes independent decisions within the scope of responsibility through a shared vision driven by the Assistant Vice President of Revenue Cycle and WMG senior leadership. He/she interacts with senior leadership, physicians, other directors, managers and all members of the Revenue Cycle within WellStar Health System, including leaders of health information management, medical staff services, managed care, corporate compliance, accounting and medical group management. The Executive Director may also work with external contacts including insurance companies, state and federal agencies, auditors, and vendors.
The Executive Director Accounts Receivable MGBO develops business plans which align and integrate resources for service excellence, employee engagement, and financial growth. He/she Mentors Directors and Managers to help establish a foundation of succession planning and leadership education. This leader is key to the creation of goals and a shared vision and sssists with the budgeting process and its completion.
Responsibilities Core Responsibilites and Essential Functions
- Strategic Revenue Cycle Relationship Management and Issue Resolution
* a.Develop and maintain positive working relationships with third party payers to facilitate the resolution of issues and expedition of payments
* b.Interact with patients and other operational departments to investigate and expedite patient or outside agency complaints, either written or oral, arising from the billing and collection process
* c.Communicate and participate in regular meetings with contracted and non-contracted payers to identify, present, monitor, and resolve operational issues related to new medical policy, products, disputed payments, and/or system-related issues
* d.Enhance and standardize work-flow processes throughout the revenue cycle to assist in achieving consistency in maintaining the critical success factors
* e.Maintain standards in the use of all software applications that are used in Physician Billing and for consistency.
* f.Leverage vendor relationships to drive enhanced performance of deployed solutions.
* g.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.
* h.Managed vendor contractual relationships, including validation of performance, deliverables and contractual obligations. - MBGO Revenue Cycle Operations
* a.Develops strategic plans and programs and ensures that goals and objectives of the team are properly defined and clearly established
* b.Develop and maintains departmental policies and procedures that are consistent with Wellstar?s mission and values.
* c.Participate in the establishment of departmental goals to best support the overall mission and objectives of WellStar
* d.Implements programs and strategies to manage and improve customer service.
* e.Continual process improvement and development of lean workflows.
* f.Demonstrate a thorough understanding of all state and federal regulatory requirements for government and third-party agencies to ensure compliance and appropriate reimbursement.
* g.Ensure assigned departments are adequately and properly staffed, reassessing workload assignments on a regular basis, maintaining productivity, and billing statistics to justify department staffing levels
* h.Monitor the current standards of productivity and quality for all staff
* i.Responsible for the effective financial and budget performance of the department as delegated in the areas of salary expense, supply expense, staffing/FTE budget and capital needs and expenditures.
* j.Develop MGBO Budget to reflect sound financial management principles and financial controls.
* k.Monitors month-end metrics, understands baseline variances and effectively provides explanation to leadership when appropriate.
* l.Assist in the development of departmental KPIs and provides the necessary direction based on performance. Designs and develops training programs that are relevant and necessary for the continuous development of the technical competencies of the team. - Regulatory Compliance and Revenue Cycle Business Requirements
* a.Maintain a strong knowledge of insurance billing and reimbursement procedures and federal, state, and local regulations related to insurance billing and collections.
* b. Ensure that all Revenue Cycle activities assigned, are conducted in compliance with all state and federal regulations, and ensure staff are properly educated to accomplish this requirement, through training and written policies and procedures.
* c.Maintains strong knowledge of insurance billing and reimbursement procedures and federal, state, and local regulations related to insurance billing and collections.
* d.Attend and / participate in obtaining information regarding routine updates provided by CMS, payors or others that impact revenue cycle operations, and communicate such information throughout the impacted areas of the company
* e. Initiate communication with peers about changes and procedures. - Teamwork and Leadership
* a.Works closely with staff, co-workers, peers, physicians and other members of the health care team to ensure a positive and effective work environment.
* b.Delegates work to staff members as needed.
* c.Establish a system to informally and formally recognize staff for accomplishments.
* d.Conducts regular and periodic meetings with the team, to ensure there is transparent communication and employee engagement towards our mission.
* e.Initiates problem-solving and conflict resolution skills to foster effective work relationships with staff/ peers/supervisors.
* f.Perform employee counseling/disciplinary action as required in a positive manner consistent with the system?s policies.
* g.Delegates work to staff members as needed.
* h.Manages staff meetings, in-services and continuing education as required for the position.
* i. Contributes to the annual review of unit/area-based scope of care/service document and determination of important aspects of care/service for clinical review.
* j. Conducts annual reviews of performance and gives on-going feedback to staff (both formal and informal).
* k.Leads and improves operational performance and quality of care/service of the service/area.
* l. Responds to problems/opportunities to improve care/service.
* m.Supports involvement in the service/area and the system?s Performance Improvement initiative(s).
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 and
- Master's Degree Preferred
Required Minimum Experience
- Minimum 12 years experience in healthcare, including 8 years of accounts receiveables experience Required and
- 7-10 years in revenue cycle, business office or other revelent management role Required and
- Demonstrated experience in financial management and knowledge of federal and state laws and requirements relating to healthcare management
Required
Required Minimum Skills
- Excellent communication skills to include oral comprehension/expression and written comprehension/expression.
- Effective problem-solving and critical thinking skills.
- Ability to manage a chaotic work environment related to changing industry needs and increasing volumes.
- Self-directed, independent thinker.
- Advanced Microsoft Word, Excel and Power Point.
- Ability and willingness to exhibit behaviors consistent with principles for service excellence.
- Strong managerial competencies in the areas of leadership and team development, managerial coaching and mentoring and situational assessment skills and with proven track record in building and developing high performing teams.
- Strong analytical skills and adept in interpreting strategic vision into an operational model.
- Ability to align departmental goals around the system?s strategic goals.
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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