Job Summary:In addition to the responsibilities listed below, this position may also be responsible for using innovative logic to drive state-of-the-art solutions used by others to process and resolve rejections and denials from insurance payers to ensure service costs are charged; and identifying trends, identifying the root cause of issues, and recommending solutions; using deep knowledge to strategically oversee the researching, coping, and mailing member-financial records to the respective requestor (e.g., court, attorney, copy services) while leading and ensuring process improvements are implemented; overseeing the execution of quality reviews and audits and develops and executes the education and coaching process for the verification and validation of insurance coverage discovery, coordination of benefits; ensures service level agreement are met for vendors to ensure the coverage for underinsured and self-pay patients is completed accurately and in a timely manner while resolving delays in vendors coverage process; promoting and championing innovative coverage programs with other service leaders; reporting staff and vendor performance to facility and regional leadership while recommending improvements for internal and external staff; partnering within the region and with local leadership to recommend and drive process improvements for obtaining third party, workers compensation, and secondary coverage payments; implementing strategies and establishing performance for Revenue Cycle locally and regionally while using expert knowledge in several professional fields to provide strategies to negotiate payment plans to set terms of pay agreement, explaining what is owed, offering discounts, and resolving escalations and implementing remediation strategies to facilitate patient care services and prevent errors with other departments; implementing strategies and establishing performance for Revenue Cycle while using expert knowledge in several professional fields to providing customer service while explaining the application process, providing direction to the organization to processing applications and disposition, follow policy regulations, provide quality assurance and ensuring quality standards are being met; assuring alignment with government audits in partnership with other departments; removing barriers to ensure MFA goals and objectives are met; resolve escalations; participates in policy review and recommendation for awarding or denying decisions of MFA committee; developing local and regional processes for consistent MFA implementation; implementing strategies and establishing performance for Revenue Cycle to ensure the team efficiency collects cost-share at time of service or post-service collections based on system deposit schedule and collect payments; monitoring closure of cash drawers; ensuring accountability for adherence and enforcing SOX regulations, signs off on certifications, and conducting remediations; issuing highly complex, organization-wide strategies used by others to demand payment of services provided; recommending and overseeing the application of new strategies and processes for continuous account monitoring, predicting bad debt exposure, proactive risk analysis, payment terms analysis and premium/provider overpayment management; propose methods to provide more financial transparency of the credit, collection, receivable and overpayment portfolios; ensuring the strategic completion of the teams process form documentation, signature obtainment, and enrollment service locations with Medicare, Medicaid, new facilities, service offers, or commercial enrollment and setting up financial reimbursement with the Treasury; approving the enrollment and maintaining signature authority of providers in Medicare, Medicaid, and workers compensation; attesting accuracy of enrollment; providing strategic oversight of cash management solutions across multiple facilities/functional areas; reviewing and recommending new solutions that drive improved cash performance; resolve barriers to issue resolution; overseeing adherence and enforcing SOX regulations while reviewing and approving SOX audit reports and action plans in compliance to the narratives; providing strategic oversight of the vendor to provide liaison for system workflows to ensure appropriate bad dept assignment and perform the reconciliation between billing system and the vendor; monitoring the collections success related to the contract; providing strategic vision and partnering with other departments to ensure resolution of the processing of credit cards and refunds by the staff are completed according to statutory timelines while making process improvement recommendations; assisting with research on simple and complex refund inquiries; approval of refund authority within FDA; responding to CMS requests; setting the timeframe processing bankruptcy, deceased, court decrees, and triage ROI requests in partnership with other groups; partnering and approving patient billing improvements, removing barriers, resolving issues, promoting innovative solutions, ensuring alignment with overall Revenue Management program goals and objectives.Essential Responsibilities:
Prepares individuals for growth opportunities and advancement; builds internal collaborative networks for self and others. Solicits and acts on performance feedback; drives collaboration to set goals and provide open feedback and coaching to foster performance improvement. Demonstrates continuous learning; oversees the recruitment, selection, and development of talent; ensures performance management guidelines and expectations to achieve business needs. Stays up to date with organizational best practices, processes, benchmarks, and industry trends; shares best practices within and across teams. Motivates and empowers teams; maintains a highly skilled and engaged workforce by aligning resource plans with business objectives. Provides guidance when difficult decisions need to be made; creates opportunities for expanded scope of decision making and impact.
Oversees the operation of multiple units within a department by identifying member and operational needs; ensures the management of work assignment completion; translates business strategy into actionable business requirements; ensures products and/or services meet member requirements and expectations while aligning with organizational strategies. Gains cross-functional support for business plans and priorities; assumes responsibility for decision making; sets standards, measures progress, and fosters resolution of escalated issues. Communicates goals and objectives; analyzes resources, costs, and forecasts and incorporates them into business plans; prioritizes and distributes resources. Removes obstacles that impact performance; guides performance and develops contingency plans accordingly; ensures teams accomplish business objectives.
Ensures the organizations work is in compliance by: reviewing trends, patterns, broader needs of the team to help create workflows and remediating while ensuring employees adhere to federal and state laws, and applicable compliance standards, and making process updates and training based on the monthly leadership quality reports.
Ensures accurate patient accounts by: reviewing and recommending new systems used to take inquires from providers, members, attorneys, and other insurance personnel to answer billing questions and evaluating new systems.
Directs the denial process by: overseeing the organizations work of performance affecting denials and ensuring effective remediation using knowledge of industry regulations and taking the teams data analysis and drawing conclusions including risks when making recommendations while also ensuring the teams complete remediation activities, also identifying trends and patters and making recommendations at the system workflow level and driving partnerships throughout the organization.
Ensures finances are completed accurately by: developing and securing budget for a assigned function budget, monitoring usage, reviewing and approving expenses, ensuring proper use of expenditures, and negotiating vendor prices.
Oversees performance management initiatives by: reviewing managers performance and developing advanced strategies to create metrics associated with the organizations performance and exercising tact and sensitivity in coaching to deliver performance improvement and contributing to the creation and implementation of information management, reporting, and analytical strategies and analytical tools. uses expert knowledge to bring together the organizations information to ensure quality of vendor performance and make decisions and developing advanced complex strategies to monitor vendor performance and remove barriers to implementation of collections, coding services, systems, coverage validation, income verification and approve vendor invoices.
Oversees process management initiatives by: using expert knowledge in several professional fields and critical information from several diverse areas to oversee the process, create strategies, plan, recommend, implement, and approve process improvements, and identify business needs with operations managers, IT, clinicians, health plan managers, and vendors while also guiding organization-wide solutions to translate business needs into project requirements that are then used to develop project specifications and action plans to drive strategic projects.
Oversees project management initiatives by: directs project execution and management efforts by directing team members to collaborate with stakeholders across functions and organizations to ensure the project is successfully executed and project-based changes are implemented.
Leads regulatory reporting by: researching, devising, and overseeing the incorporation of regulation standards into overall reporting processes and overseeing regulatory extracts while also overseeing required changed by organizing resources and driving change.
Oversees with vendor relationships by: building and managing relationship with vendors by working with internal senior management to manage execution of work in accordance with organizational guidelines while also seeking and using expert knowledge to develop complex regional procedures, guidelines, strategies, and methods for managing vendor relationships.
Oversees systems management initiatives by: partnering with systems teams to ensure that functionality aligns with operational need, approves recommended updates, and oversee operational implementation of new systems and system functionality and assess the outcomes and make recommendations.
Oversees training delivery by: developing advanced strategies to develop quality education on and implementing measures to ensure the training is well-received while also providing background when introducing new training.
Oversees the training development process by: using expert knowledge in several professional fields and critical, complex information from several diverse areas to identify education and training requirements that reflect revenue cycle changes to develop strategic training content and providing approval.
Minimum Qualifications:
Minimum five (5) years of experience in a leadership role with direct reports.
Bachelors degree in health care administration, business administration, or related field AND a minimum of five (5) years of experience in data analytics, merchant services, clinic/hospital operations, merchant services, banking, health care billing and collections, or relevant experience OR Minimum eight (8) years of experience in data analytics, merchant services , clinic/hospital operations, merchant services, banking, health care billing and collections, or relevant experience.
Additional Requirements:COMPANY: KAISERTITLE: Director, Accounts Receivable - Non MemberLOCATION: Pasadena, CaliforniaREQNUMBER: 1304622External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.