Sr Director, Revenue Operations

Company: Cambridge Health Alliance
Location: Malden
Posted on: July 29, 2022

Job Description:

Location: Commerce Place Work Days: 8:00am to 5:00pm; Monday - FridayCategory: Professional and Management Department: Revenue Cycle Administration Job Type: Full time Work Shift: Day Hours/Week: 40Union: No Union Name: Non UnionDEPARTMENT DESCRIPTION:The department provides critical oversight of the revenue cycle for Cambridge Health Alliance including actively participating in front end and back end processes.The Senior Director, Revenue Operations reports to the Chief Revenue Officer and is responsible for defining and implementing the vision, strategies and priorities of the revenue cycle and revenue operations within the CHA organization. The Senior Director serves in a strategic role managing certain revenue cycle functions at CHA requiring program planning, operations, service and budget performance, and the continual evaluation and redesign of systems by which revenue is captured and recognized for services provided by CHA and its providers.The Senior Director will coordinate with the executive leadership team to ensure that the planning and direction of comprehensive programs for revenue capture and recognition are aligned with the CHA strategic plan, and that these programs work to appropriately integrate and facilitate best practices and achieve efficiencies while maintaining quality, compliance and service delivery standards. The Senior Director actively engages with clinical leaders, providers and executive leaders to support their revenue operations and advocates for the organizational revenue cycle strategies and priorities, serves as the primary liaison for all hospital and professional charge capture matters, revenue reporting and business analysis, revenue systems and revenue cycle training, and coordinates these activities with the Revenue Cycle Leadership team. Responsibilities: In collaboration with the Chief Revenue Officer, sets goals for the Revenue Operations teams and ensures the goals and objectives are met on a timely basis Develops and maintains a collaborative working relationship with revenue producing department leaders and their providers, the Epic Information Technology team, and technical/clinical personal to ensure the programs, policies, initiatives, and tools for effective and comprehensive hospital and professional Charge Capture are implemented and being performed appropriately and effectively Reviews revenue reports, the Accounts Receivable, the Epic system configuration, etc. to identify potential system optimizations or enhancements to ensure consistent charge capture. Includes the implementation of revenue guardian checks, claim edits and DNBs to minimize or prevent revenue leakage, underpayments or denied claims Directs and facilitates the development of corrective action plans related to any deficiencies noted concerning charge capture effectiveness and system integration. These plans will be based on the proper evaluation and identification of root causes leading to the charge capture deficiencies or lack of revenue recognition Develops and executes a process to audit charge capture by identifying department(s) for periodic reviews to verify the clinical documentation supports the charges billed, to share a summary report of findings with department and Revenue Cycle leadership. Develops and maintains a collaborative working relationship with revenue producing department leaders and their providers, the Epic Information Technology team, and technical/clinical personal to ensure their revenue cycle education and training needs are being met Ensures the Revenue Integrity analysts and coders are productive and supporting the variety of operational needs of the revenue cycle. Monitors the activity in any of their assigned Epic Work Queues to ensure timely resolution and to identify root causes for the manual work Active participant on the Denials Management Team. Monitors first-time denied claims and denial write-offs to identify trends and root causes. Collaborates with the Revenue Cycle Leadership team and other key stakeholders to develop plans to prevent or minimize the denied claims and denial write-offs Develops action plans that identify all relevant or critical deliverables and tasks with responsible parties and due dates assigned Collaborates with Clinical Physician Leaders, Departments and the Epic Information Technology team to identify new technologies to aid in the charge capture process and implement when appropriate Supports the revenue operations resources responsible for providing various reports and analysis to the CHA organization informing of their operational performance or supporting the business planning process. Identifies and implements improvements to any charge capture processes and procedures to ensure timely and accurate capture of all chargeable services Develops and monitors KPIs related to charge capture and reviews metrics with the leadership of revenue generating departments Directs the design, or redesign, of CDM processes and systems to improve service and data integrity Maintains oversight of Charge Master Development, working closely with Revenue Generating Clinical Departments to ensure that the CPT/HCPCS codes, revenue codes, description, price and all other relevant charge attributes for all CDM items are appropriate and verified Ensures annual department CPT/HCPCS coding and CDM maintenance updates coincide with the CMS annual updates to the Hospital Outpatient Prospective Payment System Directly responsible for timely maintaining the contract management configuration in Epic for hospital and professional billing as well as ensuring all related groupers (MS-DRG, APR-DRG, APC, APG, etc.) and other inputs to proper claim valuations are being updated timely Reviews existing processes to ensure proper controls are in place for the maintenance and reconciliation of CDM updates utilizing CDM Manager Acts as a Subject Matter Expert for Revenue Integrity/Charge Capture and for professional and technical CDM related issues building strong relationships with the clinical departments Regular meetings with all revenue generating departments to address their billing and charge capture concerns Establishes goals and objectives for each employee to measure performance and cross training to mutually agreed-upon expectations and provides employees access to resources needed in progressing in their development plans. Ensures service and work quality meet the organizational standards of CHA and comply with state and federal rules and regulations. Utilizes work quality monitoring to ensure that policies and procedures, objectives, performance improvement, attendance, safety and environment, and infection control guidelines are followed. Monitor the growth and development needs of all their leaders and staff to ensure they are on a path to reach their full professional potential. Performs staff evaluations on direct reports as well as feedback on a regular and consistent basis via annual performance evaluations, using all available objective performance management data and personnel file information Solves problems and grievances, maintains good employee relations Oversees and completes human resource functions for team including recruiting, interviewing, hiring, disciplinary actions, performance evaluations and staff development Complete and administer the annual budget process for assigned cost centers; direct the forecast of additional funds needed for staffing, equipment, materials, and supplies; direct the monitoring of and approve expenditures; direct the preparation of and implement budgetary adjustments as necessary in conjunction with the Chief Revenue Officer. Develop and implement the organization's quality improvement plan in accordance with the mission and strategic goals of the organization, federal and state laws and regulations. Ensure that direct reports and staff receive timely and ongoing education regarding regulatory updates; coordinate audits of staff performance to ensure both strong understanding as well as corporate compliance. Incorporate CHA's values into all business staff development practices and all departmentally directed activities As appropriate, investigate or refer for investigation, potential compliance issues identified during routine reviews Safeguard the privacy and security of patient information Comply with CHA, State and Federal regulations that affect a patient's ability and access to healthcare services Foster a culture of safety and compliance through personal ownership and leading by example Adhere to patient identification policies Maintain confidentiality of all patient, personnel and company policy information in accordance with HIPAA regulations Carry out other assignments or special projects as assignedWork Experience: In-depth practical knowledge of professional and hospital Revenue Cycle Operations including hospital and ambulatory operations in a complex, multi-disciplinary environment Prior work experience in an academic medical center and safety net hospital preferred Demonstrated leadership skills including the ability to work within a team, build consensus, problem-solve, influence others outside of a direct reporting relationship, and handle conflicts diplomatically Ability to motivate the performance of cross-departmental teams towards excellence and develop team concepts through a consensus building management style Prior experience managing in a union environment a plus Prior project management experience including IT and system implementations and upgrades A mature thoughtful approach to problem-solving for all types of issues Clear, effective communication skills; ability to effectively negotiate Orientation and attention to detail Ability to work independently Practical experience with the management of medical information, hospital information systems and other tools commonly used in patient care, especially Epic Proven leader in the core functions of a complex healthcare system with a practical knowledge of day to day activities in hospital operations Prior experience leading and managing a large staff in a healthcare environment from entry level to management level Demonstrated knowledge of revenue cycle accounting processes, cost/benefit analysis and strategic planning Capable of independent work, with little to no guidance, and exercising good judgment Foster an environment in which people communicate with each other respectfully while solving problems and growing personally and professionally Provide leadership to the change management process by effectively communicating and implementing change and managing it proactively in order to minimize disruption to clinical operations, patients and revenue cycle operations Be an individual of high integrity who is comfortable working in a team environment, possessing vision, and solving problems through effective planning and management Strong analytical and advanced software skills including working knowledge of Microsoft Office programs, including Excel, Word, Powerpoint or similar programs offered by Google Ability to present design concepts and system functionality in an understandable, logical and concise manner Ability to analyze data to evaluate the effectiveness of workflows, processes, system configurations, etc. Positive communication, customer focus and interpersonal skills. Congenial and able to maintain positive working relationships Ability to learn new concepts, content, and processes quickly and apply that knowledge to further the operational goals of the organization Proven ability to coordinate and lead projects through completion Excellent communication skills, both written and verbal Excellent organizational and project management skillsMINIMUM QUALIFICATIONS: Bachelor's degree in Business Administration, Healthcare services or equivalent and/or a minimum of 7 to 10 years of progressive management and leadership experience in Revenue Operations, Revenue Integrity, Patient Financial Services and/or other related healthcare services In keeping with federal, state and local laws, Cambridge Health Alliance (CHA) policy forbids employees and associates to discriminate against anyone based on race, religion, color, gender, age, marital status, national origin, sexual orientation, gender identity, veteran status, disability or any other characteristic protected by law. We are committed to establishing and maintaining a workplace free of discrimination. We are fully committed to equal employment opportunity. We will not tolerate unlawful discrimination in the recruitment, hiring, termination, promotion, salary treatment or any other condition of employment or career development. Furthermore, we will not tolerate the use of discriminatory slurs, or other remarks, jokes or conduct, that in the judgment of CHA, encourage or permit an offensive or hostile work environment.

Keywords: Cambridge Health Alliance, Malden , Sr Director, Revenue Operations, Executive , Malden, Massachusetts