Director Revenue Cycle - Revenue Integrity Billing and Claims Management

OverviewThe Director of Revenue Cycle provides leadership and accountability for operational excellence of one or more of the major functions within Revenue Cycle. The Director of Revenue Cycle will implement effective strategies that ensures the department and organization maximizes performance, achieves goals and delivers excellent internal and external customer service. Responsibility includes assuring the overall financial health of the revenue cycle and its major front, mid and back end functions.This position provides overall operational leadership for the entire department, oversight of assigned Revenue Cycle functions and execution on daily functions. Strategic programs and priorities to achieve leading practice performance are a key priority in this role acting as a primary contributor to strong financial health of the organization. The role will possess a strong understanding of financial application and other technical solutions to leverage digital workflow in ensuring maximum efficiency and outcomes. Additionally, the role will maintain understanding of current regulatory and payer requirements and ensuring team maintains current in their application of such requirements in work completed.Director serves as a subject matter expert / technical competence and accountable leader for enterprise standardization and optimization of domain leading in world class performance in collaboration with team and partnerships. The role will lead in collaboration forums as well as act in designated liaison roles with partners and stakeholders to ensure comprehensive awareness, alignment, decision making, policy, metric transparency and performance that results in compliant and trusted outcomes for patients, providers, workforce and system.Overall responsibilities include development and oversight of operational metrics, people, plans, and programs including financial, systems/processes and internal controls for assigned Revenue Cycle functions. In addition, this position ensures that the assigned Revenue Cycle functions actively engage in continuous process improvement to enhance performance and create efficiencies. Continuous process improvement that supports exceptional patient/ family experience related to quality access, communication in the patient’s financial journey. Focus on quality, consistency, simplified, convenient and personalized service that compliments the patient’s care and assures organizational policies and standards are followed by team and partners supporting the organization. Understands, advocates (consumerism) and promotes transparency and informed decision making in compliance with industry standards and on behalf of the patient /patient’s financial rights.This role acts as a champion for workforce through active engagement leveraging organizational commitments and will lead by example. Continued investment and focus on development, growth and retention will be a vital investment creating bench while creating opportunities for department staff.Ultimately responsible for compliance and quality standards for assigned Revenue Cycle functions.ResponsibilitiesProvides Strategic Direction. Performs continuous assessment to help identify strengths, weaknesses, opportunities, and threats to revenue cycle functions. Identifies, evaluates, develops, and implements strategies and tactics to achieve organizational objectives.

Establishes performance metrics and KPI’s that align with benchmark standards and result in daily maximum output supporting strong cash flow for the organization. Ensures leaders and team alike monitor and measure performance and associated performance that result in leading practice outcomes for the organization.

Oversees functions, priorities, and staff effectiveness to ensure maximum efficiency and outcomes are achieved and work is executed in a compliant, accurate and timely manner.

Responsible for managing effective and efficient billing operations including people, processes and technology that results in leading practice clean claim creation and submission daily. This supports strong and stable cash-flow; Leads employees and influences stakeholders to follow appropriate standards, workflow as well as a systematic improvement process.

Leads the department in financial controls that ensure fully vetted, tested, and approved people, process and technology edits and changes that result in compliant and clean claim processes. Provides subject matter expertise on technical and compliance areas that impact claims processing including EPIC PB and HB system, and payor requirements.

Maintains proficiency in claim and clearinghouse solutions.

Acts as a leader, mentor and advisor with revenue oversight taskforce teams preparing and reporting on schedules related to unbilled, and billing matters requiring attention.

Manages department leadership and teams. Ensures organizational structure, job descriptions and performance are optimized. Hires, orients, and trains leadership team. Assures development and implementation of key productivity and quality standards for department processes.Establishes and works with leadership team to monitor, manage, and as appropriate related to productivity and quality as well as creating efficiency leveraging technology to achieve leading practice performance.

Guides and implements framework with leadership team that ensures routine evaluation of staff performance, meaningful feedback, coaching, and corrective action when necessary to support growth, development, and high performance.

Works with leadership and team to ensure appropriate staff education, training programs and culture of diversity, equity and inclusion are in place. Identifies opportunities and works with leadership and staff to implement plans to improve staff engagement.Establishes, maintains, and ensures appropriate education vehicles for team and customers remaining current with regulations and payer requirements.

Performs succession planning and individualized plans to provide development opportunities within the organization. Understands and follows human resource policies and procedures.

Oversees the activities of outsourced/ partnership with external vendors including implementation and on-going performance. Represents Revenue Cycle and Fairview Health Services at industry forums to network and identify process improvement opportunities.

Provides oversight to ensure compliance with established laws, regulations, practices, and procedures. Maintains self and team knowledge of, and complies with, all relevant laws, regulations, policies, procedures, and standards.

Monitors Finances. Develops and monitors budgets for assigned areas. Ensures key performance indicators are monitored and being met. identifies, evaluates, and implements, as appropriate, cost reduction opportunities Meets budget expectations. Develops and manages financial forecasts for entity. Along with senior management team, accountable for closing gap between run rate and target. Plans, directs, and oversees annual budget development and ongoing management for all areas of responsibility.

Develops Strong Working Relationships. Leads or participates in work with peers and other departments to create an excellent understanding of workflows and interdependencies, and to identify and implement strategies to improve revenue cycle performance.

Fosters a culture of improvement, efficiency, and innovative thinking.

Creates structures and processes within team and internal customers to continuously optimize and improve processes to mitigate delays, errors and defects that result in denials and write-offs and improve transparency of the patient’s financial journey.

Creates and cultivates culture of analysis, trends, issues, risk and resolution tracking with team and customers to identify patterns and appropriate solutions in a timely manner

Performs other responsibilities as needed/assigned.

QualificationsRequiredEducationBachelor’s degree or equivalence of relevant experience and years of service

Experience7 years of healthcare experience in revenue cycle functional area

5 years as a manager or director level position

License/Certification/RegistrationPreferredEducationMaster’s degree

Experience7 years leadership experience in revenue cycle functional area

License/Certification/RegistrationOne or more of the following: RHIA, RHIT, CHRI, CCS, CPC, CCS, CPC, CCS-P, RN, CDIS, DCIP

Epic Resolute Certification(s) in one or more of the following Epic applications: Resolute Professional Billing, Resolute Hospital Billing, Claims

Need help finding the right job?We can recommend jobs specifically for you!Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 12 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area and north-central Minnesota.Its broad continuum also includes 56 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.Vaccination UpdateAs part of our ongoing efforts to protect the wellbeing of our teams and to provide a safe and healthy environment for the patients and communities we serve, all Fairview employees will be required to receive both an annual flu vaccination and the COVID-19 vaccination series. Current employees must have completed both vaccination schedules on or before October 31, 2021.Beginning August 9, 2021, any new hires who are not fully vaccinated against COVID-19 are required to receive their first dose prior to their start date and their second dose (if receiving Moderna or Pfizer vaccines) within 4 weeks of their start date. Annual flu vaccinations are also required before the employment start date for employees who begin employment during the flu season.Accommodations requests will be reviewed on an individual basis.EEO/AA Employer/Vet/Disabled All qualified applicants will receive consideration without regard to any lawfully protected status.Job Locations US-MN-Saint PaulPosted Date 12 hours ago (6/22/2022 10:59 AM)Requisition ID 2022-96164Profession Business OperationsSpeciality Accounting/Finance/Human ResourcesDepartment Pricing and Charge MasterShift dayHours per 2 weeks 80Location Midway Corporate Campus