Director Revenue Cycle & HIM

SUMMARY:
Provides leadership and oversight for organization-wide programs, policies, procedures and operations of Hospital Patient Financial Services (PFS), Admitting Financial Services (AFS) and Healthcare Information Management (HIM). These departments include Hospital Billing, Collections and Cash Application, Access Services Department, Hospital Admitting/Registration Departments, Enterprise Wide Scheduling, Chargemaster Maintenance, record completion, transcription, coding, abstracting, research, filing, storage, retrieval, release of information, birth certification and associated revenue cycle functions.

ESSENTIAL FUNCTIONS:

Develops and directs organization-wide objectives, policies, and operating plans designed to ensure appropriate and cooperative functioning of financial services, excellent customer service, and optimum revenue capture.

Plans and develops medical record systems, which meet standards of various accrediting and regulatory agencies.

Directs the conformance of all regulatory guidelines pertaining to Health Insurance Portability and Accountability Act (HIPAA) Coding Guidelines and Conditions of Participation for Centers of Medicare and Medicade Services (CMS). 

Serves as the responsible officer for coding compliance and ethical standards

Manages and ensures complete and accurate responses to subpoenas and court orders for medical records; presents at depositions/court hearings as custodian of TMC Healthcare medical records.

Serves as primary resource for dissemination of information, including proposed changes in regulations and anticipated institutional impact of changes.

Serves on appropriate committees for forms development, standards, imaging and storage. Provides leadership, direction, and oversight in developing policies and procedures which support organizational goals and objectives and identifies opportunities for consolidation/cooperative efforts.

Ensures consistent application of standards and performance measures for all billing and registration-related functions to facilitate problem resolution, process improvement, and quality results.

Provides clear short- and long-term direction, guidance, and leadership to staff, managers, and executive teams in revenue cycle functions and disseminates consistent, reliable information throughout the organization.

Represents TMC Healthcare by developing and maintaining external relationships with regulatory agencies, third party payers, auditors, professional associations, vendors, and counterparts in other organizations and monitors/influences external forces impacting hospital receivables. 

Evaluates contractual arrangements with managed care plans and monitors performance/profitability of such arrangements; oversees administrative tracking of contracts.

Prepares specific budgets, monitors performance, analyzes variances and takes appropriate action.

Identifies circumstances or conditions that might hinder hospital and physician relationships or that may interfere with quality patient care.

Develops contingency plans and responds to unforeseen circumstances utilizing planned resources.

Manages staff; interviews, hires and trains; evaluates employee performance; deals with performance problems as appropriate; delegates work assignments effectively.

Ensures efficient utilization of current hospital receivables and Admitting/Registration information technologies (IT), and is conversant in recommending future IT applications to the organization.

Ensures organization-wide revenue operations are conducted in compliance with applicable federal, state, and local laws and regulations.

Directs special projects related to revenue issues, policies, and practices and delivers presentations to management and/or employees.

Adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication. 

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 institution in a related field

EXPERIENCE:   Ten (10) years of proven, progressive experience in healthcare receivables management which includes five (5) years of management experience as a Senior Manager or Director

LICENSURE OR CERTIFICATION:  CPAM (Certified Patient Account Manager), CHFP (Certified Health Care Financial Professional), Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA).

KNOWLEDGE, SKILLS AND ABILITIES: 

• Knowledge of governing regulations and standards relating to healthcare billing, collections, customer, service, admitting/registration, and contractual relations.

• Knowledge of Generally Accepted Accounting Standards (GAAP) and regulations for nonprofit institutions.

• Knowledge ofrecords management and regulations pertaining to patient medical records.

• Knowledge of revenue cycle best practices for healthcare.

• Skill in providing strong verbal and written communication and interacting with all levels within the organization and community.

• Skill in developing budgets and forecasting revenues.

• Skill in providing leadership by strategizing, complex data analysis, problem solving, decision-making, independent judgment, prioritization, and organization.

• Skill in managing and evaluating staff, making recommendations for improvement.

• Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.

• Ability to prepare detailed reports, business correspondence, and procedure manuals.

• Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.

• Ability to define problems, collect data, establish facts, and draw valid conclusions.

• Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

• Ability to calculate figures and compute rate, ratio, and percent and to draw, interpret bar graphs and apply basic algebraic concepts.