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Senior Director Patient Financial Services and Revenue Cycle Operations

Boston Medical Center (BMC) – Quincy, MA

Supporting the Hospital and the Faculty Practice Foundation, this Enterprise position is responsible for directing and managing the entire billing process for both technical and professional services, including revenue cycle information systems and business intelligence. This role also plays a leadership role with the Revenue Cycle Team, with involvement in decisions affecting all areas of the revenue cycle.

Collaborating with both hospital and physician leadership, this position works closely with Patient Access, Revenue Integrity, Coding and Case Management, HIM and Information Technology in defining vision, strategy and priority setting for enterprise revenue operations and revenue information systems initiatives, including:

  • The integration and distribution of information that contributes to the capture, management, and collection of hospital and professional patient service revenue using a holistic perspective to ensure that the business processes and information systems are operating in an integrated, efficient state to achieve maximum effectiveness;
  • Improving business processes and revenue information systems to maximize and protect the assets of the enterprise by enhancing and maintaining a properly functioning revenue cycle process through a cross-department organizational structure;
  • Establishing and maintaining key revenue cycle performance indicators for the enterprise in support of BMCs strategic plan.
  • Ensuring business operations and revenue information systems are effective and compliant with all state and federal regulations, third party payer requirements and the policies and procedures of the enterprise.

Negotiates and establishes Service Level Agreements in support of the organizations goals. Manages, communicates and aggressively pursues enterprise Accounts Receivable targets. Develops Key Performance Metrics and reports results to senior leadership.

Works with business partners to interpret trends in Key Performance Metrics which will guide management decisions for achieving the periodic goals of the revenue cycle and the overall financial performance of the enterprise.

Ensures that appropriate controls exist throughout the enterprise to create accountability and effective management of the enterprise revenue cycle.

Stays current with regulatory, third party payor and contractual changes affecting the revenue cycle to ensure compliance.

Participates and/or chairs various committees to provide leadership and lend revenue cycle expertise.

Manages and develops a results oriented team, including director, manager and supervisor levels. Continuously assesses and develops an organizational structure that ensures high performance and achievement of goals.

Facilitates the communication, coordination, and implementation of any enterprise business process or information system that has been impacted by regulatory, industry, third party payers, federal, or state requirement.

Develops and maintains departmental policies and procedures.

Ensures adequate training and education occurs to the staff in the various departments reporting to the Senior Director. This training may be specific to any regulatory, industry, third party payers, federal, or state requirements, or a course that adds a new higher level skill or builds upon an existing one, or knowledge specific to an information system, or is specific to the requirements of their roles and responsibilities.

Oversees the production and distribution of revenue cycle business intelligence for the enterprise. Collaborates with business partners to understand and determine reporting requirements, and implement negotiated Service Level Agreements.

Demonstrates through plans and actions a consistent standard of excellence to which all departmental work is expected to conform based on establishing and maintaining a constancy of purpose, focusing on continuous improvement within the Senior Director s area of influence, and delivering the highest degree of quality service possible.

OTHER DUTIES:

Completes (or contributes to the completion of) various financial forecasts, including cost center salary and direct expenses, month-end financial reporting, receivables levels (days in AR and aging), cost center productivity, and any long-range strategic plans.

Ensures the planning, coordination, and preparation for year-end audits with public accounting firms and third-party auditors as they relate to enterprise revenue operations.

Mediates and resolves conflicts regarding public accounting firms, third-party auditors, and investigative parties.

Fiduciary responsibility for ensuring that compliance standards for providing accurate information on all patient billings are followed for the enterprise.

Assesses and responds to the needs of the organization and customers with innovative programs to ensure customer satisfaction.

Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.

Directs ongoing programs for staff development, which include:

  • Hiring and training for leadership positions and directing the hiring and training of all staff in the revenue operations.
  • Completing (or directing the completion of) all necessary human resource documentation and adhering to all human resources expectations for subordinates;
  • Communicating regularly and effectively with subordinates and superiors regarding the status and condition of the business operations under control of the director;
  • Developing multi-disciplinary teams to enhance quality and efficiency.

Carries out other assignments or special projects as assigned.

JOB REQUIREMENTS

EDUCATION:

Bachelors degree required, preferably in business, healthcare or public administration, management, accounting, finance or a related field or equivalent experience in hospital revenue cycle operations. Masters preferred.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

None required.

EXPERIENCE:

A minimum of ten years of healthcare management experience in finance, revenue cycle and/or information systems. At least seven years of experience managing Patient Financial Services or healthcare business operations. At least five years in the role of a director is required.

Equivalent combinations of education and work experience will be considered.

KNOWLEDGE AND SKILLS:

The expertise of the Senior Director should include:

  • Expertise in the areas of hospital and professional revenue cycle management including scheduling, patient registration, charge entry, billing, accounts receivable (AR), reserve management, cash management requirements, revenue information systems, managed care contractual terms and requirements, health insurance practices, industry regulatory requirements, business office operations, AR and financial reporting technology, wage and hour regulations, accounting, and industry standards for healthcare revenue resolution management practices.
  • Functional understanding of health care operations and physician practices.
  • Leadership skills to motivate cross-functional teams to strive for excellence while utilizing consensus-building management styles.
  • The ability to make a significant contribution to the organization s overall effectiveness.
  • Possesses strong understanding of various reimbursement methodologies with expert knowledge of the requirements for hospital and professional billing for all payers.
  • Strong quantitative, analytic, and problem solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions.
  • Strong organizational skills to manage multiple diverse priorities with high visibility and extremely detailed information.

Ability to present and communicate complex information effectively in both written and oral forms to a variety of audiences, including hospital and physician leadership.

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