Salary: Job Summary:
This position is responsible for the workflow, supervision and management of: OHC Medical Records/HIM and the OHC Business Office. This position develops and implements new business practices to enhance organization financial performance.
Hires, trains, assigns, schedules, directs, supervises, evaluates and disciplines employees; sets priorities and deadlines; reviews and approves employee time records and expense reports; and, ensures staff adheres to established policies, processes, quality assurance and corporate compliance programs, HIPAA regulations, and all other regulatory standards.
Develops and manages annual budget; reviews financial reports with Senior Management and takes corrective action to ensure compliance with budgeting targets; assists in the preparation of projections to support new services, employee recruitment, and/or revenue sources.
Supports new program development by advising on development of fee arrangements for new or special services; analyzes fee structures and provides semi-annual fee and revenue reassessments; proposes fee structure revisions based on local, regional, and tertiary fair market pricing assessments and opportunities for net revenue improvement.
Keeps abreast of all health reimbursement related issues and initiatives as they apply to the tribal programs, and offers education and technical assistance in regard to these changes to GPTCHB staff and administrative and tribal representatives.
Evaluates processes and procedures within scope of the revenue cycle operations for quality standards of care, recommends changes to meet the organizational goals of the OHC.
Assists with the development of business documents (encounter forms, PDA formats), to ensure appropriate selection and reporting of services in compliance with funding protocols, AMA and federal guidelines, and HIPAA requirements.
Analyzes and improves the performance of business operations through development and monitoring of performance criteria: patient registration, insurance verification, data entry, charge and diagnosis assignment and charge capture activities.
Regularly review that internal policies and procedures are followed that maintains patient confidence and protects operations by monitoring confidential information processing.
Lead the establishment and implementation of Key Performance Indicators (“KPIs”) for revenue integrity functions; ensure the implementation of action plans where performance is not meeting expectations; review KPI expectations annually and adjust appropriately; recognize areas of excellence.
Develop, implement, and oversee effective and consistent operational policies, processes, tools, and educational materials within all Revenue Integrity functional areas.
Responsible for processing enrollments of health care providers; entering, updating, and maintaining NPI and any other applicable provider numbers into the applicable programs.
Oversee the operational performance of a system-wide, service line-based Charge Review program dedicated to identifying charge capture issues/improvement opportunities to minimize revenue loss, through the use of technology enablers and proactive internal audits/reviews of charging practices.
Ensure that the CDM is compliant with regulatory and payer requirements and that all services provided have an established charging methodology.
Identify potential process improvements in charge capture functions and lead the design and implementation as required.
Monitor and facilitate service level agreements (“SLAs”) between Revenue Integrity operations and other related functions within both Revenue Cycle and Clinical operations. This includes confirmation that charge review queues/requests are managed appropriately.??
Build strong relationships and facilitate productive communication between key Revenue Cycle stakeholders, including peer leaders of Revenue Cycle services and core support departments (e.g., human resources, IT, finance).
Develop, implement, and manage efficient and effective operational policies, procedures, processes and performance monitoring across all revenue integrity functions.
Serves as the lead in standardizing accounts receivable and incorporating internal controls into business office systems by ensuring compliance with regulations and established timeframes within the Revenue Cycle.
Ensure audit of denial management processes occurs consistently and coordinate with peers across the revenue cycle organization, and with other related stakeholders, to identify trends and implement denial prevention/recovery programs.
Oversee, measure, and report ongoing financial and operation performance of Revenue Integrity and denial management.
Support OHC strategic initiatives that require involvement from revenue integrity functions as required.
Assess direct reports’ performance on a consistent basis and provide feedback to reward effective performance and enable proactive performance improvement steps to be taken.
Perform other related duties as assigned.
Effectively plan, organize workload and schedule time to meet the demands of the position.
Work in a cooperative and professional manner with GPTCHB staff.
Treat Great Plains tribes and collaborators with dignity and respect.
Utilize effective verbal and written communication skills.
Advance personal educational development by attending training sessions and seminars as appropriate.
Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and guests.
Foster a work environment of wellness, courtesy, friendliness, helpfulness and respect.
Relate well and work collaboratively with coworkers and all levels of staff in a professional manner.
Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or personalities.
Maintain and ensure organizational privacy and confidentiality.
Handle crisis and tolerate stress professionally.
Be self-directed and take proactive initiative to assist others.
Resolve issues with other departments and coworkers without direct supervision if needed.
Exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment.
Promote an alcohol, tobacco and drug-free lifestyle.
Embrace modes of appearance and attire that reflect a professional presence.
Adhere to GPTCHB policies and procedures.
Strong working knowledge of billing and collection processes and functions, charging processes and general revenue cycle management strategies, and industry best practices.
Thorough knowledge of metrics, analytics, and data synthesis in healthcare revenue integrity and revenue cycle management to identify trends, produce reliable forecasts and projections.
Strong analytical and critical-thinking, organizational, and business process optimization skills, with in-depth ability to develop and pursue goals, synthesize data to identify system vulnerabilities and develop and apply innovative solutions.
Ability to effectively present information and respond to questions from patients, groups of managers, clients, customers, and the general public.
Knowledge of AMA, HIPAA, and applicable federal, state laws, regulations, and federal guidelines, and Medicare and Medicaid rules and regulations.
Knowledge of CPT, ICD-10 coding and Hospital/Physician billing.
Knowledge of all aspects of third party reimbursement policies and practices.
Knowledge of medical office practices, procedures, and equipment related to processing and recording of billing and reimbursement records and transactions; managed care industry; third party insurance enrollment and claims processing.
Knowledge of generally accepted accounting principles; basic business data processing principles and practices as applied to billing and collections of medical patient accounts.
Knowledge of business English usage, spelling, grammar and punctuation.
Knowledge of business acumen.
Ability to work independently and make sound judgments within established guidelines; understand and apply oral and written directions; establish and maintain effective working relationships; exercise sound administrative judgment in quickly evaluating emergency situations and rendering prompt decisions, must be a team player.
Ability to understand, interpret and apply instructions, policies and procedures related to processing and recording of billing, registration records, enrollment and reimbursement transactions; business math including fractions, decimals percentages and ratios.
Ability to gather, organize, analyze and present data to appropriate sources.
Ability to interpret and apply local, State, and Federal rules and regulations accurately and effectively.
Ability to develop and maintain strong interpersonal relationships with team members, internal stakeholders and external constituents; ability to influence change through these relationships.
Ability to take direction and work independently, take initiative within areas of responsibility, as well as provide leadership and direction while working in a team-oriented environment.
Ability to exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment.
Ability to effectively present information in one-on-one and small group situations to community members, consumers and other employees of the organization.
Skill in researching, reading, interpreting and writing technical specifications and documentation.
Skill in establishing and maintaining effective working relations.
Skill in operating a personal computer utilizing a variety of software applications.