Website Highmark Health
This job provides senior leadership, effective management and overall oversight of the strategic and operational aspects of revenue cycle operations. Provides strategic direction and guides implementation required for the patient visit from point of entry to accurate adjudication of the patient account. Advises and oversees investments and changes in software applications, outsourcing vendors, recovery projects and other interventions to collect the net revenue associated with patient services delivered. Focuses on the harmonization of the current revenue cycle operations of WPAHS, PLZ, JRMC, SVHS in addition to any other physician organizations acquired or developed as part of Allegheny Health Network. The incumbent develops and implements a comprehensive strategic plan and establishes clear objectives and priorities for the successful integration of current disparate people, process and technology across the organization. Serves in a leadership role to ensure the financial viability of the organization through the provision and management of the revenue cycle in such a way as to assure optimal performance. Supports sustained financial viability for organization by managing the development of achievable financial plans, identifying opportunities through variance analysis, and designing and maintaining operational monitoring tools.
Develop the necessary internal infrastructure to build a consolidated and standardized revenue cycle model inclusive, but not limited to the following processes: centralized scheduling, pre-registration, insurance verification and pre-certification of all scheduled services.
Identify and develop a virtual CBO leveraging the identification of local, standardized and centralized functions.
Oversee the development and implementation of service standards and operating systems to optimize patient flow and revenue including information systems, patient flow and access, insurance verification, financial counseling, charge master/revenue integrity, Health Information Management (HIM)/Coding, Patient Financial Services and other interdependent functions which impact the financial yield of the revenue cycle.
Maintain appropriate internal control safeguards over A/R records and collection of cash. Maintain compliance standards for providing accurate information for all AHN billings.
Plan, coordinate and prepare year-end audits with public accounting firms and third party auditors as they relate to A/R operations.
Ensure compliance with relevant regulations, standards and directives from regulatory agencies and third party payers.
Oversee and enhance the development of the data collection, analysis and reporting processes for the executive management of the revenue cycle including information integrity validation and interpretation.
Continuously enhance the patient and physician service delivery aspects of the revenue cycle, including monitoring patient satisfaction survey data, physician satisfaction survey data and other data points to refine the procedures that impact the delivery of service and customer satisfaction.
Coordinate and facilitate assigned financial/revenue cycle committees and other task forces, such as ICD-10 Planning.
Provide leadership and advisory services relative to the design and implementation of a call center strategy and integration of current AHN call centers. The scope of this includes multi-disciplinary internal and external access centers.
Assess and respond to organizational and customers’ needs with innovative programs to ensure customer satisfaction.
Assist with ensuring cost effective and efficient processes and outcome management for internal and external customers.
Maintain a collaborative and supporting relationship with other management staff at all systems facilities and encourages subordinates to do likewise to ensure integration of patient processes that will achieve optimal patient outcomes.
Monitor revenue cycle external contracts/relationships, performance and service levels, including functions outsourced, core and bolt-on technologies, specialty recovery vendors and collections agencies.
Establish metrics and provides clear line of site to executive leadership. KPI’s inclusive of but not limited to: Gross Days in A/R, Cash to net, Facility DNFB, Bad Debt as a % GPR, Charity as a % of GPR, Final Denials, Credit Balancing, etc. Ensure that goals are met and maximizes net revenue collectability from all third party payers.
Participate in financial forecasting and planning along with other members of the management team.
Ensure completion of various financial forecasts including cost center salary and direct expenses, month-end financial reporting, receivable levels, cost center productivity and any long range and strategic plans for the department.
Other duties as assigned or requested.
Bachelor’s Degree in Healthcare Administrative, Management Accounting, Finance or other related specialty
15 years of progressive revenue cycle experience with a minimum of 10 years at the executive leadership level
Demonstrated experience with a major systems conversion (EPIC preferred)
Demonstrated experience with transformative change and demonstrated performance within a broad scale (500+ employees) revenue cycle operation
Hands-on experience in various areas of patient access, registration, billing, credit and collection, and cash management
LICENSES AND CERTIFICATION
Languages (Other Than English)
0% – 25%
PHYSICAL. MENTAL DEMANDS and WORKING CONDITIONS
Teaches/trains others regularly
Travel regularly from the office to various work sites or from site-to-site
Works primarily out-of-the office selling products/services (sales employees)
Does Not Apply
Physical work site required
Lifting: up to 10 pounds
Lifting: 10 to 25 pounds
Lifting: 25 to 50 pounds
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
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