SR DIRECTOR RCM BILLING OPERATIONS

SR DIRECTOR RCM BILLING OPERATIONS 

Job Description

JOB SUMMARY: Provides strategy, decision support, organizational planning and operational leadership to drive the insurance billing and follow up processes for all Cleveland Clinic entities. This includes decision support and planning on reimbursement, billing, and insurance collection issues.

JOB RESPONSIBILITIES: Provides strategic direction, leads innovations and operational enhancements/standardization by leveraging best practices and technology to create best in class corporate accounts receivable insurance billing operations. Collaborate to build and implement efficiency strategies around first pass payment rate. Develops a comprehensive strategy to respond to current and future challenges presented by legislation, compliance, health care reform in order to monitor and address changing revenue cycle practices. Demonstrates strong strategic thinking, collaboration, leadership, problem solving and communication skills with all levels of the organization. Demonstrates a consultative approach when working with physician partners, institute leaders and vendors to develop efficient, patient- focused solutions. Maintains functional accountability for the insurance claiming function, follow up, denials distribution and a significant operation of denials remediation based on type of denial. Provides management supervision and direction for designated regional centers; accountable for operation of designated center to include: budget preparation, salary administration, equipment purchases, and establishment of annual goals and objectives. Assists billing operations to meet corporate goals for cash collections, net revenue comparisons, and billing expense. Ensures compliance with all federal, state, and local regulations governing rendered patient services and reimbursement. Ensure consistent implementation of corporate financial policies for A/R issues such as: insurance small balance write offs, controllable loss, agency use and contract terms. Other duties as assigned.

EDUCATION: BS or BA in healthcare or business related field. Advance degree preferred.  

LICENSURE/CERTIFICATION/REGISTRATION: None required.

COMPLEXITY OF WORK: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

REQUIRED EXPERIENCE: Ten or more years of progressive leadership and managerial experience in a large, multi-facility Hospital, Clinic or Group Practice Hospital (Physician led preferred). Extensive knowledge of operational revenue cycle management with EPIC experience preferred. Ability to build engagement to drive effective results. Demonstrated successful project management skills and implementation of complex multiple system integrations. Must be highly organized and able to coordinate many simultaneous activities. Professional presentation, consulting and communication skills.. 

PHYSICAL REQUIREMENTS: PERSONAL PROTECTIVE EQUIPMENT: Follows standard precautions using personal protective equipment as required.

CANDIDATE DETAILS

10+ to 15 years experience

Management Experience Required - Yes

Minimum Education - Bachelor's Degree

Willingness to Travel - Occasionally

SKILLS AND CERTIFICATIONS

Do they use EPIC

IDEAL CANDIDATE

Proven experience in RCM and large volume billing

IDEAL CANDIDATE SHOULD HAVE WORKED FOR THE FOLLOWING COMPANY(IES): Large physician led healthcare systems