Director Patient Accounting

SUMMARY

Reporting to the Senior Director Revenue Cycle this position is responsible for the oversight and management of all patient financial services for hospital and professional billing. Possessing a high level of discretion and judgment, the Director serves as an advisor to the department management and Directors, Clinical Chairs, and Connecticut Children’s leadership on matters related to reimbursement, charge capture, denials management profitability and impact on revenue cycle. The Director works collaboratively with Accounting, Revenue Integrity, Patient Access, Decision Support, and Connecticut Children’s Specialty Group and the Compliance Office to ensure proper billing, charging, costing, and financial statement representation of clinical services.

ROLE RESPONSIBILITIES

• Responsible for goal setting and management of the staff assigned to Clinical Business services including but not limited to Cash Collections and the Billing Office. 
• Function as the leader and resource for department chairs, providers, clinical department staff, and Connecticut Children’s leadership on topics related to the Billing Office.
• Through extensive analysis of data, observations of workflow, and in consultation with Revenue Integrity and leaders, identify opportunities to ensure capture of all hospital and professional billable services while concentrating on operational efficiencies, proactive engagement with business partners and elimination of wasted redundancies. 
• Work collaboratively with finance, revenue cycle, IS leadership and decision support staff on any information system changes necessary to maintain and improve the appropriateness of Third Party Contractual Allowance calculations.   
• Provide analysis and reporting for revenue cycle performance in key metrics including billing, collections and accounts receivable results and provide trends to Connecticut Children’s leadership. Identify and implement appropriate interventions based on these metrics and in alignment with industry Best Practices. 
• Maintains strong understanding of revenue cycle metrics and leads team in building plans to support operational departments to achieve best practice performance through strong analytical capabilities, process improvement identification, and technology enhancements.
• Develops a high-performing team that provides superior project management skills and supports each revenue cycle department implement LEAN processes to drive improved financial performance at a lower cost-to-collect.
• Maintains strong understanding of Epic functionality and leads team in identifying and implementing functionality that improves revenue cycle performance, streamlines workflow, and reduces cost-to-collect.
• Demonstrates understanding of key revenue cycle areas including, but not limited to: insurance verification, pre-registration, financial counseling, coding, billing, collections, denials/underpayments, customer service, vendor management, CDM, charge capture, utilization review.
• Develops highly functioning leadership team through successful hiring, mentoring, training and coaching in order to achieve the highest level of competency of leadership and staff.
• Forecasts operational needs and applies lean methodology in developing annual budgets to reduce costs and ensure fiscally responsible revenue cycle operations which align with short and long term goals
• Responsible for the coordination of activities and ensures continual compliance with regulatory standards.
• Ability to work independently, be self-motivating, self-guiding, proactive, strategic and able to consistently prioritize projects. Strong organizational and time management skills required.  Ability to react quickly to analyze problems and recommend solutions is essential. 
• Interpret and recommend appropriate action steps to take place as a result of reports, analyses, and data setting forth recommendations for progress, implementation and avoidance of adverse trends and conclusions. 

Supervisory Duties (if applicable)

Manages direct reports

Minimum Education and Experience Required

• Master’s degree in Business, Accounting, Health Administration, Health Sciences, Management Engineering, Finance or related field and a minimum of 10 years related health sciences, finance, or revenue management preferred. Equivalent combination of education and experience will be considered. 

• Strong EPIC experience in ARCR: Resolute Hospital Billing Director and ARCR: Resolute Professional Billing Director highly preferred. 

Position Specific Job Education and/or Experience

                                                                                 License and/or Certification

Required: N/A

Preferred: N/A

                                                                              Knowledge, Skills, and Abilities

KNOWLEDGE OF:

Thorough knowledge of federal and state billing rules and regulations, fraud and abuse legislation, billing compliance, HIPAA privacy and security regulations, and risk management. Solid knowledge of medical billing compliance rules, including those for academic institutions, e.g. teaching physician documentation guidelines with special attention on Government Payer regulatory and coverage guidelines.

Strong knowledge of hospital operations management and patient billing required.  Revenue integrity would be preferred. 

Considerable knowledge of computer networks, and operations, including EPIC, Electronic Health Records with the ability to act as the liaison between IS, Billing, and Decision Support to achieve Connecticut Children’s Goals. 

SKILLS:

Excellent managerial, decision-making, business intelligence, decision support, analytical, planning, prioritization, problem resolution and leadership skills.

Ability to analyze data, systems and procedures for opportunities involving quality or process improvements and education and make recommendations in both a visual and verbal Executive Presentation.

Excellent written and oral communication skills with an exemplary customer service approach to business interactions. 

Advanced computer skills in Excel, Access, and PowerPoint required. 

ABILITY TO:

Ability to read, analyze, interpret, summarize, present and implement technical procedures, financial reports, governmental regulations and guidelines. Develop clear conclusions and summarize findings for non-financial leaders. Broad and detailed understanding of managed care business processes and third party reimbursement methodologies including the calculation and projections of Third Party Liabilities.

Strong operational fluency with benchmarking products with the ability to reverse engineer conclusions is highly preferred.