UNIVERSITY CLINICAL, EDUCATION & RESEARCH ASSOCIATES (UCERA) POSITION DESCRIPTION Position Title: Revenue Cycle Director Date Prepared: 12/11/2008 Department: Administration FLSA Status: Full-time, Exempt 100% UCERA FTE Position Reports To: COO Potential Occupational Exposure to Bloodborne Pathogens: No UCERA is a non-profit organization established to further the mission and vision of the John A. Burns School of Medicine at the University of Hawaii (JABSOM). It contributes to JABSOM's goal of improving the health care status of the citizens of Hawaii and the Pacific by supporting the education, research and clinical activities of the School. It supports financial diversification of the School by developing revenue generating initiatives in collaboration with hospitals, government agencies and other entities. POSITION SUMMARY The Director of Revenue Cycle maximizes the efficiency of submission and collection of claims, provides leadership of the staff involved in the generation of revenues derived from the delivery of clinical services, and provides advice to management regarding policy and procedures regarding the revenue cycle. The position requires advanced skills in the management and implementation of revenue cycle improvement initiatives. This position will direct activities that lead to measurable and sustainable improvements. The Director develops and manages policies and procedures to optimize all facets of revenue cycle operations and staff compliance with all applicable policies and procedures; makes recommendations with regard to participation in health plans and efficiency of provider enrollment, and directs revenue cycle projects as the subject matter expert based on best practices for quality and revenue performance, documentation, coding, and appropriate charge capture. Functions of the department include governmental and non-governmental medical professional billing, health plan participation, provider enrollment, accounts receivable, coding, charge capture and maintenance, collections, denials, rejections, low payment monitoring, professional credit balance, and contract compliance. ESSENTIAL JOB DUTIES AND FUNCTIONS Performs analyses and projects future improvements, estimating improvements in revenues, productivity and efficiency by improvements in processes. Reviews health plan contracts and makes recommendations with regard to participation. Ensures efficiency and timeliness of provider enrollment. Coordinates efforts with functions to establish organization-wide metrics, processes, procedures, templates and collaborative tools to support revenue cycle. 1
Works with the Chief Operating Officer and administrative staff to develop and foster strong strategic relationships across functions, department and entities; and facilitates senior management sponsorship and commitment to key constituents. Develops an ongoing communication strategy for numerous management and non management staff and consultants throughout the organization for the delivery of regular updates, ensuring sharing of knowledge and implementation of business and technology systems across departments. Establishes a methodology for project prioritization and implementation that ensure strong internal controls which support and are in alignment with operational, governance, and compliance structure, as well as regulatory compliance, and internal policies. Ensures adherence to applicable federal and state laws and regulations, compliance requirements, accreditation and licensing requirements, and policies and procedures. Ensures that all revenue management functions are coordinated and meet the clinical and patient financial services requirements for revenue management. Facilitates a collaborative process to develop a long range plan for comprehensive and compliant revenue cycle with optimal efficiency and accuracy across the departments, while understanding organizational complexity and priorities and incorporates knowledge into plans. Supports leadership in the definition and attainment of organizational goals. Partners with a broad range of leadership and staff to provide leadership, coordination, guidance, and influence to develop strategies and set strategic vision for best practice revenue cycle operations program wide and for improving revenue cycle capabilities and performance, while ensuring alignment & coordination across operational areas relative to the revenue cycle. Oversees detailed work plans to ensure high quality deliverables and adherence to timeframes and budget. Acts as subject matter expert in the functional areas of Documentation & Coding, and Charge Capture and act as a strategic thought partner to management, making significant contributions and providing leadership to highly visible management initiatives to identify and resolve issues related to revenue cycle design. Oversees, motivates, mentors, and supports assigned staff numbering about 60 through the supervision of directors, managers and assistant managers of the central business office; serves as a role model for staff. Supports compliance by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting noncompliance to the COO and the board, and adheres to applicable federal, state and local laws and regulations, accreditation and licensure requirements, and UCERA s policies and procedures. Performs all other duties as assigned. JOB CONDITIONS Normal working conditions, indoors, air-conditioned. Usual hours are Monday-Friday, 8:00 a.m. to 5:00 p.m. Hours may be flexed to accommodate clinic schedules, and duties may require extended hours. Must have excellent written and verbal communication skills. Requires communication with staff, medical school clinical department faculty and staff, and with clients and contractors. 2
EQUIPMENT USED Skilled in use of office equipment (i.e., Facsimile, printers, copiers, computers). Computers using Excel, Word, Visio and GE/IDX billing system. MENTAL AND PHYSICAL DEMANDS Works with minimal supervision; attention to detail, accuracy and concentration, and demonstrates ability to maintain a calm composure while performing multiple tasks. This position occasionally requires lifting items up to 30 pounds, frequent sitting, standing, walking and bending. Some driving between meeting sites as necessary. MINIMUM QUALIFICATION REQUIREMENTS Skills/Knowledge: Familiarity with medical billing project management, business process management and workflow design. Financial management skills associated with physician practice management. Demonstrated understanding of the operations and/or business of a large healthcare system, revenue cycle management, especially functional areas of IDX Billing, quality, documentation & coding, and charge capture, and applicable regulations related to the responsible practice area. Knowledge of applicable compliance requirements, approaches for implementation and industry interpretations Knowledge or exposure to Epic electronic medical records system. Proven leadership skills in a matrix management environment that includes influencing, efficiency, collaboration, candor, and openness with a focus on results orientation. Advanced interpersonal communication skills (written and verbal) to deal effectively in delicate, sensitive and/or complex situations with a wide variety of influential internal and external parties. Strong presentation skills, with experience presenting to senior level executives and leadership groups. Demonstrated ability to determine the key business issues and develop appropriate action plans from multidisciplinary perspectives. Thorough knowledge of complex project management processes, tools, techniques and methodologies to lead large scale effort. Education/Training: Master s Degree in Healthcare Administration, Business Administration, Public Health, Health Science, Accounting, Finance or related field. 3
Certified Public Accountant, Certified Internal Auditor, or Certified Management Accountant or other related certification. Experience: 7 10 years of management experience in revenue cycle management within a medical school faculty practice organization, or large physician group setting working with GE s Group Management system (formerly known as IDX Groupcast) Minimum 7 years experience in healthcare provider revenue cycle process improvement and managed care environment Experience in directing day-to-day operations of a large-scale, high volume revenue cycle department Experience with patient accounting, healthcare and professional billing, and multi-specialty group practice Experience in managing complex, large scale projects and establishing detailed work plans and setting priorities. Experience in contract negotiations including structuring payment methodologies. Experience with supervision and management of staff. 5 years experience serving as a Revenue Cycle Consultant. Experience working in a medical school environment interacting with Deans, Clinical Department Chairs, and Clinical Faculty members. Experience aligning the goals and objectives of the revenue cycle process with a medical school s clinical goals and objectives. Other qualifiers: Proven experience in development and achievement of revenue cycle goals and objectives to include staff performance measures and reporting results Demonstrated track record of aggressively decreasing receivables and increasing cash collections without adverse impact on employee morale or customer satisfaction Communication and interpersonal skills necessary to establish credibility and work effectively with physicians, department managers, and staff Detail orientation and good organizational skills. Ability to meet deadlines and achieve goals in an environment with competing priorities Ability to conceptualize, implement, and monitor new processes Demonstrated ability to function in a highly professional manner, exercising complete confidentiality and discretion at all times. Attention to detail and ability to accurately synthesize lengthy, complex materials. Proficient in using MS Word and Excel, with a working knowledge of databases and electronic communications. Excellent English grammar and proofreading skills. Strong oral and written communication skills. 4
Excellent customer service skills with the ability to interact positively and sensitively with staff and the general public. Successful experience working as a team member with a multicultural staff and clientele. TERMS OF EMPLOYMENT Position is located in the Administrative Office and is available immediately. Continued employment subject to terms of employment, job performance and/or continued funding. Employment is at will and can be terminated at any time, either by the employee or UCERA, with or without cause or reason and with or without notice. ABOUT THE SALARY AND BENFITS UCERA offers a competitive package. Salary commensurate with education and experience. Benefits include 13 holidays per year, 100% employee coverage for health and dental, flexible spending plan, pension plan with 3% dollar-for-dollar company matching contributions, 2 weeks of paid vacation after 90 days of service, and 100% company paid group life insurance and employee assistance program. INTERESTED APPLICANTS Qualified applicants are encouraged to email a cover letter, resume, and salary requirements to jobs@ucera.org or fax at 808-536-7315. UCERA is an Equal Opportunity Employer. www.ucera.org 5