Director Revenue Cycle - Hospital Inpatient and Outpatient Coding

Director Of Revenue Cycle Management Coding Operations

The Director of Revenue Cycle Management coding operations provides leadership and accountability for operational excellence of one or more of the major functions within Revenue Cycle. The Director of Revenue Cycle will implement effective strategies that ensures the department and organization maximizes performance, achieves goals and delivers excellent internal and external customer service. Responsibility includes assuring the overall financial health of the revenue cycle and its major front, mid and back end functions. This position provides overall operational leadership for the entire department, oversight of assigned Revenue Cycle functions and execution on daily functions. Strategic programs and priorities to achieve leading practice performance are a key priority in this role acting as a primary contributor to strong financial health of the organization. The role will possess a strong understanding of financial application and other technical solutions to leverage digital workflow in ensuring maximum efficiency and outcomes. Additionally, the role will maintain understanding of current regulatory and payer requirements and ensuring team maintains current in their application of such requirements in work completed. Director serves as a subject matter expert / technical competence and accountable leader for enterprise standardization and optimization of domain leading in world class performance in collaboration with team and partnerships. The role will lead in collaboration forums as well as act in designated liaison roles with partners and stakeholders to ensure comprehensive awareness, alignment, decision making, policy, metric transparency and performance that results in compliant and trusted outcomes for patients, providers, workforce and system. Overall responsibilities include development and oversight of operational metrics, people, plans, and programs including financial, systems/processes and internal controls for assigned Revenue Cycle functions. In addition, this position ensures that the assigned Revenue Cycle functions actively engage in continuous process improvement to enhance performance and create efficiencies. Continuous process improvement that supports exceptional patient/ family experience related to quality access, communication in the patient's financial journey. Focus on quality, consistency, simplified, convenient and personalized service that compliments the patient's care and assures organizational policies and standards are followed by team and partners supporting the organization. Understands, advocates (consumerism) and promotes transparency and informed decision making in compliance with industry standards and on behalf of the patient /patient's financial rights. This role acts as a champion for workforce through active engagement leveraging organizational commitments and will lead by example. Continued investment and focus on development, growth and retention will be a vital investment creating bench while creating opportunities for department staff. Ultimately responsible for compliance and quality standards for assigned Revenue Cycle functions.

This position is fully remote.

Responsibilities

Provides Strategic Direction. Performs continuous assessment to help identify strengths, weaknesses, opportunities, and threats to IP and OP Coding Functions. Identifies, evaluates, develops, and implements strategies and tactics to achieve organizational objectives.

Oversees functions, priorities, and staff effectiveness to ensure maximum quality, efficiency, throughput, and outcomes are achieved and work is executed in a compliant, accurate and timely manner.

Establishes performance metrics and KPI's that align with benchmark standards and result in daily maximum output supporting strong cash flow for the organization. Ensures leaders and team alike monitor and measure performance and associated performance that result in leading practice outcomes for the organization.

Responsible for managing effective and efficient coding operations including people, processes and technology that results in leading practice clean claim creation and submission daily. This supports strong and stable cash-flow; Leads employees and influences stakeholders to follow appropriate standards, workflow as well as a systematic improvement process.

Provides oversight to ensure compliance with established laws, regulations, practices, and procedures. Maintains self and team knowledge of, and complies with, all relevant laws, regulations, policies, procedures, and standards

Leads the department in financial controls that ensure fully vetted, tested, and approved people, process and technology edits and changes that result in compliant and clean claim processes. Provides subject matter expertise on technical and compliance areas that impact claims processing including EPIC HB system, and payor requirements.

Guides and implements framework with leadership team that ensures routine evaluation of staff performance, meaningful feedback, coaching, and corrective action when necessary to support growth, development, and high performance.

Works with leadership and team to ensure appropriate staff education, training programs and culture of diversity, equity and inclusion are in place. Identifies opportunities and works with leadership and staff to implement plans to improve staff engagement. Establishes, maintains, and ensures appropriate education vehicles for team and customers remaining current with regulations and payer requirements.

Acts as a leader, mentor and advisor with revenue oversight taskforce teams preparing and reporting on schedules related to unbilled, and billing matters requiring attention.

Manages department leadership and teams. Ensures organizational structure, job descriptions and performance are optimized. Hires, orients, and trains leadership team. Assures development and implementation of key productivity and quality standards for department processes. Establishes and works with leadership team to monitor, manage, and as appropriate related to productivity and quality as well as creating efficiency leveraging technology to achieve leading practice performance.

Performs succession planning and individualized plans to provide development opportunities within the organization. Understands and follows human resource policies and procedures.

Oversees the activities of outsourced/ partnership with external vendors including implementation and on-going performance. Represents Revenue Cycle and Fairview Health Services at industry forums to network and identify process improvement opportunities.

Monitors Finances. Develops and monitors budgets for assigned areas. Ensures key performance indicators are monitored and being met. identifies, evaluates, and implements, as appropriate, cost reduction opportunities Meets budget expectations. Develops and manages financial forecasts for entity. Along with senior management team, accountable for closing gap between run rate and target. Plans, directs, and oversees annual budget development and ongoing management for all areas of responsibility.

Develops Strong Working Relationships. Leads or participates in work with peers and other departments to create an excellent understanding of workflows and interdependencies, and to identify and implement strategies to improve revenue cycle performance.

Fosters a culture of improvement, efficiency, and innovative thinking.

Creates structures and processes within team and internal customers to continuously optimize and improve processes to mitigate delays, errors and defects that result in denials and write-offs and improve transparency of the patient's financial journey.

Creates and cultivates culture of analysis, trends, issues, risk and resolution tracking with team and customers to identify patterns and appropriate solutions in a timely manner

Performs other responsibilities as needed/assigned.

Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served

Partners with patient care giver in care/decision making.

Communicates in a respective manner.

Ensures a safe, secure environment.

Individualizes plan of care to meet patient needs.

Modifies clinical interventions based on population served.

Provides patient education based on as assessment of learning needs of patient/care giver.

Fulfills all organizational requirements

Completes all required learning relevant to the role

Complies with and maintains knowledge of all relevant laws, regulation, policies, procedures and standards.

Fosters a culture of improvement, efficiency, and innovative thinking.

Performs other duties as assigned

Required Qualifications

B.S./B.A. Bachelor's degree. In lieu of degree, candidate would need 4 years experience with content/technical knowledge and demonstrated capability to deliver results (this would be in addition to the experience listed below).

5 years related experience

5 years people leadership experience

One or more of the following: RHIA, RHIT, CHRI, CCS, CPC, CCS, CPC, CCS-P, RN, CDIS, CDIP

Preferred Qualifications

M.A./M.S. in Health Information Management or related field

7 years management experience in a Health Information Management department or Coding division

5 years coding experience

One or more of the following: RHIA, RHIT, CHRI, CCS, CPC, CCS, CPC, CCS-P, RN, CDIS, CDIP

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more!