Job Details

INTRODUCTION

Under the supervision of the Director of Patient Financial Services, the Associate Director of Patient Financial Services will assist in driving the overall operational results, controls and measurements of Patient Financial Services to maximize productivity and collections. Helps Director to formulate strategy and optimization of revenue cycle operations, systems, policies and procedures to apply improvement to insurance eligibility processes, charges, claims processing, payments, collections and Accounts Receivable, denials, reporting of results and analysis.

MAJOR DUTIES/ESSENTIAL FUNCTIONS

Essential and other important responsibilities and duties may include, but are not limited to the following:

• Monitors and tracks revenue cycle queues and backlogs.
• Ensures performance targets are met, and that adequate and appropriate staffing levels are available to meet performance metrics.
• Assists in training staff.
• Continually works on performance improvement measures that maintain or exceed key metrics to their benchmarks. Assist in creating and modifying policies and procedures to address customer needs, compliance, efficiency, and internal control requirements.
• Assists with and implements changes to the patient billing system.
• Liaises with outside companies and third-party payors to identify and resolve EDI issues.
• Responsible for file maintenance functions of the EMR in accordance with payers Billing standards and Reimbursement policy and procedures, including patient billing, statements, claim submissions electronic and paper, and ANSI file maintenance.
• Helps improve customer service, operational effectiveness and financial outcomes.
• Performs trend analysis on third party payer payment levels to ensure that reimbursement is in accordance with allowable amounts stated in agreements and contracts. Works with appropriate individuals to resolve discrepancies.
• Assists Director in the preparation of financial analysis for use in the third party and managed care negotiation payer process.
• Collaborates with Director and Finance Department to explain net revenue variances for the month end.
• Prepares monthly updates on the status of key performance measures for the Director and financial leadership.
• Communicates and implements new payer requirements that impact AR and ensures changes are appropriately communicated and trained with staff members.
• Maintains A/R and revenue for PFS business line, providing key balance sheet and P&L line items to finance for month end close, budget process, audits and ad hoc reporting.
• Develops and implements standard reports to provide pertinent information on the overall effectiveness of the medical services revenue cycle process.
• Continuously monitors, evaluates, and makes recommendations to the Director regarding information technology requirements affecting the medical services revenue cycle process.

QUALIFICATIONS

The ideal candidate will possess the following qualifications to be considered.

• Bachelor's degree in healthcare, Business or other related field of study.
• Minimum of eight (8) years of relevant revenue cycle management experience at a manager level or above
• Five (5) years of multi-specialty medical group revenue cycle experience.

REQUIRED KNOWLEDGE, SKILLS, AND ABILITIES

• Exhibits strength of character to champion risk-taking and be a self-starter and self-motivated to bring Unity into the future.
• A working knowledge in the areas of patient access, billing, coding, accounts receivable and cash management requirements, health insurance, business office operation, credentialing and Health Information Management (HIM).
• Ability to work under pressure and independently with minimal supervision.
• Ability to work in a team-oriented environment and interrelate well with individuals with diverse ethnic and cultural backgrounds and needs.
• Effective, clear, and persuasive oral and written communication skills with individuals and groups.
• A proficient working knowledge of medical terminology, CPT, HCPCS, and ICD10; Certified Coder (AAPC or AHIMA only) is preferred.
• A high level of interpersonal skills to handle sensitive and confidential situations. Position continually requires demonstrated poise, tact and diplomacy
• Demonstrates a working knowledge of health center operations with strength in patient flow/appointment scheduling/registration/encounter form processing.
• Must possess a working knowledge of patient accounting operations.
• Experience with EClinicalWorks or Epic is strongly preferred.
• Must be highly organized.

PHYSICAL REQUIREMENTS

Requires no heavy lifting, and nearly all work is performed in an office environment. Specific vision abilities required by this job include close vision and ability to adjust focus. Frequently required to sit, use hands/fingers to handle or feel, and talk/hear. Requires critical thinking, organizational, decisive judgment, communication, good customer service skills. Must be able to handle multiple tasks, be able to work in a stressful environment and take appropriate actions as needed. Must always follow Unity Healthcare and departmental policies and procedures.