Asst. Vice President, Revenue Cycle - Physician Billing Office

Overview

Manages the patient accounts receivable for all WellStar Medical Group (WMG) practices provided within the WellStar Health System. Oversees six primary areas, four areas with a dedicated Director which include medical group billing/insurance and patient follow-up, insurance cash management, denials/ payment variance, revenue integrity and medical group customer service. Performs complex data analysis and makes independent decisions within the scope of responsibility through a shared vision driven by the Vice President of Revenue Cycle and other senior leadership. Interacts with senior leaders, physicians, other directors, and all members of the Revenue Cycle within WellStar Health System, including leaders of health information management, corporate compliance, accounting and medical group revenue cycle. External contacts consist of patients and their families, insurance companies, state and federal agencies, auditors, and vendors. Develops business plans which align and integrate resources for service excellence, employee engagement, and financial growth.

Responsibilities

Core Responsibilites and Essential Functions

• Provide operational direction and leadership for areas of the Medical Group Billing Office assigned, including professional billing/charge capture/follow-up/insurance cash application (including credits, refunds, and cash posting), revenue integrity, denials, payment variance and customer service.
• Maintain a strong knowledge of insurance billing and reimbursement procedures and federal, state, and local regulations related to insurance charging, billing and collections.
• Ensure that all Revenue Cycle activities assigned, are conducted in compliance with all state and federal regulations, and ensure staff are properly educated to accomplish this requirement, through training and written policies and procedures.
• Maintain, update as appropriate, and enforce the adherence to Revenue Cycle and system written policies, procedures, and processes.
• Develop and monitor productivity and quality metrics and benchmarks for each area of the Revenue Cycle based on industry standards. Monitor productivity and quality of each area using metrics and provide feedback to management regularly (monthly as a minimum).
• Develops leadership teams appropriate for department needs.
• Develops and implements strategic plans and budgets; monitors performance to expectations.
• Oversee the unbilled accountablity structure for claim and billing edits.Work closely with the WellStar Connect team to ensure an effective implementation of new billing systems, identify opportunities for system or process improvements with WellStar Connect and beyond, and drive change through targeted initiatives.
• Oversees the DNFB/Unbilled accountablity structure for claim and billing edits.
• Report and review key metrics and progress on outstanding initiatives with the Vice President of Revenue Cycle on a regular basis.
• Maintains strong knowledge of insurance billing and reimbursement procedures and federal, state, and local regulations related to insurance billing and collections.
• Identify opportunities for system or process improvements and drive change through targeted initiatives.
• Facilitate regular staff meetings to communicate departmental and organizational issues, goals, achievements, and changes.
• Responsible for the effective budget development and financial performance of the department as delegated in the areas of salary expense, supply expense, and capital needs and expenditures.
• Select, evaluate, counsel, and discipline as required in a positive manner consistent with health system policies.
• Maintain a system to informally and formally recognize staff for accomplishments.
• Demonstrate excellent customer service through oral and written communication in providing assistance/expertise to patients, families, and other external or internal contacts.
• Assures development of 90 day plans that support the achievement of system goals
• Possess strong physician relation building skills.
• Proficiently use all systems and processes applicable to the job.
• Serve as role model and mentor to co-workers
• Perform other duties and responsibilities as assigned

Professional Communication

• Maintain confidentiality in matters relating to patient/family.
• Interact with patients/families with a variety of developmental and sociocultural backgrounds.
• Provide information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity, and caring.
• Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies.
• Initiate communication with peers about changes and procedures.
• Relay information appropriately over telephone, email, and other communication devices.
• Participates as active part of WellStar Senior Leadership to assist in identifying and achieving corporate strategic goals and objectives.
• Maintains detailed knowledge of System strategies and objectives; identifies opportunities for improvement and ensures Division, Hospital, and Medical Group initiatives are consistent with and contributing to System objectives.
• Maintains knowledge of healthcare environment both locally and nationally to identify opportunities and threats; communicates internally as appropriate and incorporates into planning process.
• Actively participates with the Operations Group, and other teams that support System goal achievement.

Teamwork

• Accept assignments based on needs and the qualifications and competencies of self and of other staff members.
• Work closely with other staff, co-workers, peers, and other members of the healthcare team to ensure a positive and effective work environment.
• Delegate work to other staff members as needed.
• Report to appropriate personnel regarding assignments, projects, etc.
• Initiate problem solving and conflict resolution skills to foster effective work relationships with peers.
• Report to work on time and as scheduled.
• Actively participates in corporate initiatives, committees and group discussions to contribute to sound policies and decisions.
• Actively attends and participates in committees as assigned.
• Identifies how structure or function could be improved and communicates appropriately
• Promotes team development through active leadership presence in group and committee structures.
• Have an ability to organize and present data in a concise and easily understood manner, often to professionals, physicians and board members.

Professional Development

• Attend staff meetings, in-services, and continuing education.
• Contribute to annual reviews of peer performance as requested by the unit/area supervisor or manager.
• Assist in the development of indicators, thresholds, study methods, and data collection as assigned.
• Respond to problems/opportunities to improve care/customer service.
• Support involvement in system performance improvement initiative.
• Participate in and maintain competencies required for the position and specific unit/area(s) of assignment.

Required for All Jobs

• Performs other duties as assigned
• Complies with all WellStar Health System policies, standards of work, and code of conduct.

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Qualifications

Required Minimum Education

• Bachelor's Degree in Business, Accounting, Finance or related field. Required and
• Master's Degree in Health Care Administration, Nursing, or Business Administration or equivalent.. Required

Required Minimum Experience

• minimum 10 years physician accounts receivables experience Preferred
• Hospital accounts receivables experience Preferred
• minimum 7 years of progressive leadership including director level responsibility in a complex healthcare organization. Required
• Exceptional business acumen including experience in contracting or group purchasing Required
• Exceptional interpersonal skills for written, verbal, presentation, and computer communication Required
• Experience with leading integration or other large transformation projects is Preferred

Required Minimum Skills

• Knowledge of state and federal regulations as they pertain to billing processes and procedures.
• Knowledge of insurance claim processing and third party reimbursement.
• Knowledge and detailed understanding of all negotiated agreements.
• Knowledge of the principles of Information Systems in order to effectively analyze and make decisions.
• Skill in good oral, written, and interpersonal communication.
• Skill in problem solving in a variety of settings.
• Skill in technical or professional accounting.
• Skill in time management and project management.
• Ability to work efficiently under pressure.
• Ability to operate a computer and related applications. Advanced proficiency in Microsoft Excel.
• Ability to apply appropriate supervisory, management and leadership techniques in an operational setting.
• Ability to work independently and take initiative.
• Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
• Ability to deal effectively with constant changes and be a change agent. Ability to deal effectively with difficult people and/or difficult situations.
• Ability to willingly accept responsibility and/or delegate responsibility.
• Ability to set priorities and use good judgment for self and staff.

We'd like to invite you on a career journey like no other! In return for your contributions, we'll help you make the most of all life's moments - on and off the job. Wellstar Total Rewards is designed to provide for your total well-being, including: Your Wellness, Your Pay, Your Future, Your Joy. We think it's pretty simple - we care for our team members and our team members care for the community.

Make a difference in patients' lives... and your own! Here, it's more than healthcare - it's CareerCare!