Director Patient Financial Services

SUMMARY:

Directs daily operations related to the development, maintenance, and configuration of Patient Financial Services. Leads a team of billing professionals and collaborates with various departments to optimize billing and follow-up procedures. Responsible for developing, planning, organizing, and implementing Revenue Cycle strategies.

ESSENTIAL FUNCTIONS:

Responsible for all Patient Financial Services functions for all TMC Healthcare facilities.  

Directs and participates in the planning process for future development and growth of the business; periodically presents such plans for general review and approval by Administration.

Develops and implements strategies to enhance operations within Patient Financial Services, including efficient claims processing, AR follow-up activities, denials management and cash reconciliation to meet defined goals and objectives.

Monitors regular billing audits for adjustments, denials, appeals, and customer account reconciliation projects and communicate findings to appropriate clinics and departments while assisting in resolutions.

Regularly interacts with vendors while monitoring performance and contractual obligation. Works with the management team to establish A/R and industry performance metrics and monitoring and reporting on performance against established metrics.

Verifies patient satisfaction of the billing processes and ensuring contractual requirements of our collection venders are meeting expectations and requirements.

Enforces a collaborative approach across the enterprise to ensure an integrated approach to meet revenue requirements and patient expectations. Serves as a subject matter expert to proactively identify opportunities to improve the revenue cycle and assist in resolution of issues.

Adheres to TMC organizational and department-specific safety, confidentiality, values, policies and standards.

Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION: Bachelor’s Degree from an accredited college or university.

EXPERIENCE: Seven (7) years of progressive management-level experience including five (5) years’ experience within an acute care hospital environment.  Three (3) to five (5) years of recent HB Epic experience.

LICENSURE OR CERTIFICATION: None required.

KNOWLEDGE, SKILLS AND ABILITIES: 

·         Thorough knowledge of health care reimbursement methods.

·         Thorough knowledge of current practices, regulations, and techniques in access services. 

·         Knowledge of building and supporting teams and collaborative workgroups. 

·         Knowledge of Medicare and AHCCCS regulations relevant to access services. 

·         Skill in conflict management. 

·         Skill in strong verbal and written communications.

·         Skill in tactful interaction with providers regarding compliance best practice guidelines, utilization of hospital resources, documentation requirements, and other case management issues.

·         Ability to demonstrate proficiency in reading and interpreting documents and other information related to insurance billing and collections, including, fee schedule, provider numbers, provider status, Medicare and other federal regulations, payer contracts, authorization & insurance eligibility.

·         Ability to listen actively and respond to employees, physicians, patients, and payer issues in a competent manner. 

·         Ability to present positive internal and external communication and effectively represent TMC care management. 

·         Ability to identify external and internal changes and engage in responsive initiatives or actions both functionally and system wide. 

·         Ability to effectively lead and work within teams.