The Executive Director of Patient Financial Services is responsible for overseeing the Business Office functions, including billing, follow-up, and collections of patient accounts. This role focuses on compliance with payer regulations, employee productivity, and improving key revenue cycle indicators. The Executive Director will lead strategic revenue management initiatives, collaborate with various stakeholders, and implement standardized policies and processes to enhance the revenue cycle's efficiency and effectiveness.
Essential Job Functions
• Develop and recommend potential organizational policy changes to the System Chief Financial Officer and implement approved changes.
• Assist with the development of budgets and monitor department operations to achieve goals within budget.
• Maintain extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.
• Oversee account statuses based on Days on AR, DNFB, CFB, and communicate expectations to billing management.
• Serve as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS.
• Review and enhance insurance verification, coding review, billing, and collection processes for efficiency and best practices.
• Review, monitor, and recommend updates to the CDM fee to maximize reimbursement
• Interact with vendors while monitoring performance and ensuring contractual obligations are met.
• Review performance data to monitor and measure departmental productivity and effectiveness.
• Attend leadership meetings and disseminate information to department managers and staff.
• Collaborate with the Senior Leadership team on addressing provider concerns related to RVUs, coding, and billing.
• Partner with Finance to analyze the reimbursement's impact on financial performance.
• Stay current on federal and state regulations related to reimbursement and billing for durable medical equipment.
• Work closely with legal and compliance teams to ensure adherence to applicable laws and guidelines.
• Establish objectives to accomplish physician practice and hospital service line goals.
• Identify opportunities for performance improvement, including increased efficiencies and cost reductions.
• Co-Chair with the Director of Case Management the denials prevention committee.
• Improve metrics such as days to bill, days in accounts receivable, and bad debt expense.
• Deploy a management toolkit and report card metrics to enhance performance in key indicators.
• Interview, hire, train, evaluate, and develop subordinate management staff.
• Establish standards for conduct and performance, and ensure compliance with these standards.
• Model a culture of excellence for the department.
• Provide feedback to management regarding potential changes to improve staff performance.
• Develop and implement a communication plan with staff input.
• Participate in leadership growth and development.
Minimum Qualifications
Education
• Minimum Bachelor's Degree and Minimum of 5 years of leadership experience in a directly related role.
• Preferred Master's degree or Minimum of 10 years leadership experience in a directly related role.
Experience
• Minimum of 5 years of leadership experience in a directly related role.
• Thorough understanding of EDI standards for electronic claims submission.
• Strong knowledge of medical insurance billing and collections, CPT, ICD-10, and HCPCS coding.
• Solid understanding of Oracle EHR, preferred
Certifications and Licenses
• Coding Certification or RHIT At hire
• RHIA Preferred
• Must possess a valid Montana driver’s license at the time of hire and be eligible for coverage under the organization’s motor vehicle insurance policy.
Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered. Employees that require a licensed or certification must be properly licensed/certified and the licensure/certification must be in good standing.