Associate Director Revenue Optimization

POSITION SUMMARY

Supports the VP of Revenue Cycle Operations and Optimization in managing aspects of revenue cycle optimization, including maintaining relationship and monitoring of third-party billing organization and EPIC hosting organization, identifying and implementing revenue optimization strategies, regulatory compliance with third-party insurers (Medicaid, Blue Cross/Blue Shield, etc.), and maintenance of billing and reporting systems. Supports fee schedule, contract review and credentialing activities for managed care contracts.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES

Management (10%)

· Recruits, retains and develops a diverse and highly qualified staff; provides ongoing performance feedback and maintains a safe and professional work environment.

· Trains or assists in training staff in other departments on revenue cycle related areas (both administrative and program) as needed.

· Evaluates staff in a timely manner in accordance with PPGNY’s policies.

· Performs other training and mentoring related duties as required.

Revenue Cycle Optimization and Revenue Cycle Liaison (55%)

· Performs analysis of revenue cycle trends and identifies areas of focus to reduce denials and increase overall collections.

· Performs root cause analysis for areas identified, proposes solutions to achieve overall enhancement of revenue and implements changes.

· Develops workplans to address billing corrections needed, works closely with EPIC hosting organization to implement automated solutions

· Collaborates with third party RCM vendor and health center operations to implement process changes.

· Collaborates with cross functional teams to ensure alignment between clinical operations and PPGNY billing practices

· Tracks adherence to process changes implemented and quantify financial impact.

· Monitor health centers’ adherence to charge reconciliation processes and metrics measured by key performance indicators and work with HC leadership to address issues/ trends identified

· Ensure changes within the charge description master (CDM) coincide and are implemented with clinical systems

· Review changes in CPT®, HCPCS, and revenue codes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursement

· Develop, deliver, and revise integrity education and training programs in coordination with clinical operations and leadership

· Perform revenue integrity reviews and present findings for corrective actions

Monitoring tools (25%)

· Develops and implements reporting tools to identify revenue cycle trends, including root cause of denials.

· Builds reporting tools to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third-party RCM vendor.

· Creates reports to monitor the impact of RCM enhancements and ensure compliance with new processes.

· Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance.

Monitoring tools (25%)

· Develops and implements reporting tools to identify revenue cycle trends, including root cause of denials.

· Builds reporting tools to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third-party RCM vendor.

· Creates reports to monitor the impact of RCM enhancements and ensure compliance with new processes.

· Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance.

Education and Training (10%)

· Evaluates the results of the periodic coding audits conducted by an outside agency, and partners with the VP of Revenue Cycle Operations and Optimization and clinical services leadership to provide training and feedback to the clinical providers on their performance and areas for improvement.

· Actively maintains an up-to-date knowledge base of developments in third-party billing, such as changes in Medicaid reporting requirements. Identifies changes required to department procedures in response to such developments.

· Responsible for identification of training needs for all registration areas and provide training material working in conjunction with RDO of operations.

· Maintain up to date knowledge of CMS billing rules and payer requirements to proactively identify policy changes

· Remain current on payer billing requirements

· Remain current on Epic reporting tools

CORE COMPETENCIES

· A demonstrated commitment to PPGNY’s mission related to bodily autonomy, health equity, gender and racial justice

· A demonstrated commitment to learning about and enhancing practices related to racial equity and its impact on healthcare systems.

· Strong relationship building and communication skills, including an ability to work and build trust across cultural differences related to related to race, class, age, gender, gender identity and expression, sexual orientation, religion, ethnicity, national origin or ability; and to reflect on one’s personal identity with humility.

· Strong knowledge of data and analytics to ensure good decision making, performance measurement and financial analysis.

· Ability to work collaboratively in cross-organization workgroups.

· Customer service and interpersonal skills and the ability to coordinate work with others, both internally and externally, to accomplish tasks.

· Engages in mutual problem solving

· Facilitates continuous process improvements

· Strong time management skills, including ability to work in a high distraction environment and to juggle multiple deliverables at one time

· Strong project management skills, identifying all steps required to meet a deliverable, key stakeholders, deliverables by other units in order to achieve goals, and barriers to success.

REQUIRED SKILLS/ABILITIES:

Interpersonal

· Excellent customer service and communication skills

· Ability to remain focused and calm in stressful situations

· Excellent interpersonal, written and verbal skills

· Ability to develop and maintain effective, professional relationships with internal and external stakeholders

· Ability to work effectively as part of team

Technical

· Proficient with Microsoft Office Suite; Advanced Excel skills including Pivot Tables and V Look Ups

· Deep understanding of EMR systems; Experience in an EPIC environment

· Strong data management and data analysis skills; research oriented with the ability to critically analyze large data sets

Subject Matter Knowledge

· In-depth knowledge of Medicare/Medicaid regulations, including billing, coding, and documentation requirements.

· Strong experience in revenue cycle management and optimization

· Previous experience with Charge Master Management

· Experience with principles of process improvement

Work Habits/Attributes

· Excellent organizational skills

· Outstanding time management skills, including the ability to work under deadline

· The ability to produce high quality work in a fast-paced environment with changing and/or competing priorities

· Ability to exercise sound judgment and independent decision-making skills

· Ability to produce reliable, high-quality work with minimal direct supervision

· Ability to exercise discretion in the handling of confidential information

· Possess strong work ethic

REQUIRED QUALIFICATIONS

• Minimum of an associate degree in business administration, accounting, healthcare administration, or other related degree.
• 10 years of experience related to billing, coding, denial management and underpayment analysis
• Demonstrated leadership skills
• Two years’ experience with EPIC Reporting.

Preferred Qualifications:

• Bachelor's degree in Finance or IT related areas of focus
• EPIC related certifications and reporting experience
• Coding certification (e.g. CCS, RHIA, RHIT) or applicable experience

TYPICAL PHYSICAL DEMANDS

• Requires prolonged sitting and repetitive tasks including use of a computer. Periodic standing, walking, bending. Requires lifting or moving of up to 15 pounds. Visual acuity sufficient to perform frequent work on a computer screen and review printed reports and other materials. Requires the ability to hear and to communicate orally with others. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets, and will require reaching, grasping, pushing and pulling.

TYPICAL WORKING CONDITIONS

• This job operates in a professional office environment. Potential exposure to communicable diseases and other conditions in a health center environment. Requires flexible schedule and during peak activity periods work in excess of 7.5 hours per day and/or 37.5 hours per week.