• Responsible for claims processes from submission to issue resolution and account settlement.
• Accountable for oversight and optimization of revenue cycle governance with primary focus on functional areas including but not limited to Billing, Revenue Integrity, Insurance/Patient Account Follow-Up, Customer Service, Cash Posting, Denials Management, Payment Variance, and Collections
• Prompt identification and timely reporting of insurance reimbursement issues and trends.
• Reviews, designs, and implements processes and Electronic Health Record (EHR) workflows to support overall revenue cycle functions.
• Monitors daily operating activity of medical claims Billing department staff, and makes necessary adjustments in work assignments
• Supervises the revenue cycle department in various duties, such as account management, communications with insurance providers, cash posting, contract analysis, and billing.
• Establishes strategies, goals, metrics, and timelines for long-range planning of the Revenue Cycle Department and its initiatives.
• Manages staff, interviews, hires and trains, evaluates employee performance, manages performance problems as appropriate, delegates work assignments effectively.
• Works in conjunction with EBF leadership on strategic projects and annual plans

Skills: Claims Management, Revenue Cycle Governance, Issue Identification, Process Design, Staff Supervision, Goal Setting, Performance Management, Workflow Optimization

• Define, track, and drive vital company metrics like revenue collection rate
• Collaborate with Care Operations, Family, Provider Growth, and Clinical teams to build and operate cross-functional systems that produce accurate, timely revenue collection
• Hire and manage a high-performing RCM team
• Set weekly, monthly, and quarterly goals for improving the health of revenue cycle
• Monitor accounts and providers for possible credentialing issues affecting reimbursement and drive quick resolution
• Educate, train, and motivate other teams to uphold and improve billing processes over time
• Create a helpful, responsive experience for families who escalate billing issues and questions
• Oversee all revenue cycle activities for the organization
• Track analytics/metrics and report to Senior leadership
• Manage relationships with payers and providers
• Set strategies and implement improvements for billing and collections
• Oversee a good size department through Managers who report directly to the role

Skills: Revenue Metrics, Cross-Functional Collaboration, Team Management, Goal Setting, Credentialing Management, Staff Training, Billing Support, Relationship Management

• Collaborates closely with clinical leadership to support the clinical service goals of the organization. 
• Those goals include but are not limited to: Charge capture for services performed, Charge Description Master supervision in conjunction with Reimbursement
• Work with finance function regarding revenue recognition, Cash collection, Minimizing bad debts and denials.  
• Coding compliance for technical, professional and ambulatory services, Registration and scheduling, Customer satisfaction.
• Responsible for supervision of revenue cycle personnel. 
• Communicates expectations for revenue cycle performance, sets monthly, quarterly and annual goals that allow consistent cost-effective measures.
• Manages contractual relationships with insurances, works closely with Finance to maintain an effective vendor contracting strategy.
• Drives on-going corporate compliance vigilance and monitoring.
• Develops and implements policies and procedures related to all areas of the revenue cycle.
• Leads integration of revenue cycle systems and infrastructure with current and future practices.
• Builds effective relationships and collaborates with other operational leaders to ensure that revenue cycle expectations are being met, keeps the executive leadership well informed.
• Keeps abreast of industry trends and monitors impact on business performance and competitive advantage as related to revenue cycle.

Skills: Clinical Collaboration, Charge Capture, Revenue Recognition, Coding Compliance, Staff Supervision, Contract Management, Corporate Compliance, Policy Development

• Informs and works with the CFO to solve problems related to billing, collections and EOB reporting.
• Meets with CFO and CPSH team members to assess, plan, implement and evaluate programs and processes to increase the efficiency and effectiveness of the business operations at CPSH.
• Collects data and maintains reports of operational expenses as well as routine statistics for CPSH.
• Promotes, builds and ensures positive customer/patient relationships at all levels within the hospital.
• Reviews and creates processes surrounding admissions, billing, collections, third party payor relations and compliance.
• Ensures tracking mechanisms surround coding errors and billing turnaround times.
• Updates CFO of significant activities.
• Deals discretely with sensitive, confidential information concerning staff performance and CPSH/Patient operations.
• Assesses and resolves all third party payer and patient billing issues using appropriate resources within CPSH.
• Delegates and prioritizes daily work activities of the admissions, insurance and billing staff

Skills: Problem Solving, Process Improvement, Data Collection, Customer Relations, Compliance Management, Billing Tracking, Confidentiality, Staff Management

• Establish standards of excellence and quality for revenue cycle management
• Work with leadership to develop policies to ensure revenue cycle efficiency
• Create revenue cycle management KPI's, monitor performance and implement improvement
• Takes ownership of billing and collections and collaborates with leadership to resolve issues/problems in a timely manner and prevent their recurrence
• Drive processes that achieve financial results for billing, collections and payment processing. 
• Review and ensure timely follow-up on outstanding items and assist in the resolution of billing audits
• Conduct and oversee denial analysis, implement denial reduction initiatives and reduce overall denials
• Partner with others to ensure timely, accurate, and compliant billing and coding activities
• Manage plan contracts as well as credentialing for appropriate payment
• Assist in hiring, training, and measuring and managing productivity of the team
• Help identify inefficiencies and create and implement process improvement activities
• Serve as an internal consulting resource on revenue cycle management

Skills: Revenue Management, Policy Development, KPI Monitoring, Billing Ownership, Denial Reduction, Audit Resolution, Contract Management, Process Improvement

• Experience in software engineering in multiple domains or products.
• Strong expertise in Java, J2EE, SQL, and deeper knowledge in REST, Web-based solutions, APIs
• Experience in Microservice and Cloud-native development, Modernization of enterprise products
• Proficiency with Agile development methodologies and added preference for taking the teams through agile transformation
• Expertise in scaling and improving the performance of solutions to support the growing needs of concurrent users.
• Hands-on experience in fully automated DevSecOps including Continuous Integration, Continuous Testing, Continuous Delivery, and Continuous Deployment.
• Hands-on experience in Architecting and designing multiple high complex enterprise cloud-deployed applications.
• Deeper knowledge of building enterprise-level Architectural framework and Technology platforms.

Qualifications: BA in Finance with 12 Years of Experience

• Management and Supervisory skills
• Must have a strong mathematical aptitude.
• Experience working in an EHR with Hospital and Physician Billing.
• Must be able to produce and complete accurate work.
• Must be proficient in Microsoft Excel.
• Must be able to maintain confidentiality and work well under pressure.
• Must have a neat appearance and pleasant personality, with the ability to deal with a variety of constituents.
• Experience in the health information management field, preferably as a manager.
• Must have a thorough knowledge of medical and hospital terms.
• Excellent written and oral communication skills, including computer capabilities.

Qualifications: BA in Health Information Management with 4 Years of Experience

• Experience working with third party healthcare payors, particularly collections and cash applications
• Strong knowledge of claim adjudication functions
• Working knowledge of finance and reserves
• Demonstrated ability to work effectively across departments to deliver results
• Advanced knowledge of claims clearinghouses and 837/835 data requirements
• Experience working with healthcare payors in a leadership role focused on collections
• Experience in managing accounts receivable with responsibility for Days Sales Outstanding
• Experience presenting complex information in an organized fashion in both verbal and written form.
• Demonstrated working knowledge of the revenue cycle and coding as well as the ability to interpret programming logic associated with HL7 interface activity.
• Experience performing complex reconciliations.

Qualifications: BA in Accounting with 7 Years of Experience

• Progressive experience in a multi-facility health system.
• Experience directing Revenue Cycle activities for a large hospital, medical group, and/or healthcare system.
• Proven ability to determine key business issues and facilitate/support the development of effective action plans from multidisciplinary perspective.
• Excellent skills in complex analytic problem solving, strategic planning, program development, project management, change management and group process.
• Demonstrated ability to manage multiple initiatives, identify and prioritize issues to meet aggressive timelines and organizational goals.
• Excellent written, oral and interpersonal (negotiation and listening) communication skills are required for interacting with all levels of health care professionals within the organization.
• Demonstrated experience managing through influence and collaboration with providers and executives, both inside and outside an organization.
• Advanced proficiency in all Microsoft computer applications and other job-related networks and software.
• Ability to function effectively in a Labor/Management Partnership environment.
• Must be able to work in a Labor/Management Partnership environment.

Qualifications: BA in Business Administration with 8 Years of Experience

• ICD-9/10 coding experience 
• Active Professional Medical Coding Certification 
• ICD-10 Coding Certification
• Be a strong and caring people manager with exceptional interpersonal and management skills
• People management/team leadership experience 
• Experience recognizing and understand compliance issues.
• Capability to lead and influence senior leadership around business issues.
• Organization and multi-tasking skills.
• Ability to handle sensitive, confidential information.

Qualifications: BA in Healthcare Management with 5 Years of Experience