The Vice President of Revenue Cycle is responsible for the leadership, integration and standardization of patient access processes to facilitate patient access, financial services, and health information management within CARTI. Partnering with physicians, the VP of Revenue Cycle will implement processes that maximize the prompt seamless acceptance of patients within all levels of care at CARTI. Develop and implement robust systems for financial clearance and facilitate prompt access and add value for patients and referring physicians.
Areas of responsibility include: Pre-Certification, Registration, Charge Capture, Billing, Coding, Claims Submission and Aging, Collections and Payment Posting, Central Referral Office, Switchboard, Pre-Registration, Medical Records, Cancer Registry. Demonstrates and communicates the mission, ethics, and goals of CARTI in day to day communications and actions. Responsible for optimizing cash collections within the rules and regulations governing health care accounts receivable.
Responsible for hiring, training, evaluation, scheduling and supervision of Revenue Cycle leaders and staff reporting to this position and approving all staff hires in these departments. Also, acts as chargemaster coordinator. Must be able to manage multiple projects and handle potentially stressful situations, as well as must work as collaborative team member at all times with other CARTI leaders and team members.
EDUCATION, CERTIFICATION, LICENSURE and REGISTRATION:
1. Bachelor's degree with an emphasis in business, accounting or healthcare administration
EXPERIENCE, KNOWLEDGE, SKILLS and ABILITIES:
1. Minimum 10 years' healthcare financial supervisory experience.
2. Minimum 10 years' clinic or hospital Patient Access experience.
3. Minimum 10 years' experience with EMR, billing, patient accounting and registration systems.
4. Previous experience with system conversions, system integrations.
5. Previous experience in acquisitions, integrations of health care systems and EMRs.
6. Previous experience with computer spreadsheet and data processing programs.
7. Knowledge of Medicare and Medicaid rules and regulations.
8. Must be outcomes driven, as a valuable team member, always putting the team above the individual.
9. Must be able to demonstrate and communicates the mission, ethics, and goals of CARTI.
10. Must be a proven innovator, given current economic health care environment.
11. Enthusiastic, self-motivated and committed to excellence.
JOB SPECIFIC DUTIES AND RESPONSIBILITIES:
1. Hires, trains, supervise, evaluate and assist the Revenue Cycle leaders. Is responsible for oversight of leaders' duties and responsibilities.
2. Establishes department objectives, policies and procedures and evaluates effectiveness. Emphasizes teamwork and encourages front line staff involvement in providing input.
3. Follows-up on Medicare and Medicare replacement plan accounts, including research, patient contact, obtaining reviews, rebilling, no-pay or balance after billing and appeals.
4. Responsible for Medicare credit balance accounts, refunding Medicare, Medicaid other carriers when necessary reports. Responsible for Medicare Secondary Payer (MSP) education and carrier updates regarding refunds.
5. Reviews and approves refund requests for patient accounts at determined dollar amount.
6. Prepares and manages budgets for Revenue Cycle teams.
7. Keeps current on all regulatory changes regarding accounts receivable and health information management and communicates and implements changes and training when necessary. Ensures compliance within department with all CMS regulations and audit requirements.
8. Reviews accounts from internal collection efforts on a monthly basis for collections action (e.g. collection agency, litigation, etc.) Reviewing with Assistant CFO when appropriate.
9. Maintains CARTIs charge master, including price changes/edits, new charge codes, description changes, CPT/HCPCS applications, annual price increases and revenue code applications. Works with managers to ensure their charges and CPT/HCPCS are correct. Oversees audits after all changes to ensure testing did not miss anything.
10. Oversees administration and maintenance of electronic billing and remittance software. Ensuring consolidation of EMR and billing systems to a standardized CARTI system process.
11. Coordinates testing of updates to relevant computer module and communicates changes to personnel and trains when necessary.
12. Oversees daily processing and month end closing of systems. Provides daily, weekly and monthly summary.
13. Maintains dictionaries ensuring that bills, statements, reports, reminders etc. print correctly and accurately and that changes and new entries flow correctly.
14. Maintains certain MIS dictionaries, such as the insurance dictionary ensuring that the changes and/or creation of new entries flow through and are entered on all other coordinating dictionaries.
15. Responds to audit requests by insurance companies, and participates as needed in audits and surveys performed by regulatory agencies.
16. Supports report development to provide patient account/financial services and other areas reports as requested to ensure effective audit and review and to instill the impact of everyone's contributions.
17. Assures confidentiality for all patient/customer information as per CARTI policy.
18. Supports and demonstrates CARTI's strong commitment to the highest standards of business and professional ethics. Encourages all staffs engagement in this effort.
19. Participates in appropriate CARTI committees as assigned.
20. Handles special projects as assigned.
21. Directs counsel to patients as to financial responsibilities; identifies financial options available and assists patients whenever possible.
22. Maintains good public relations with physician offices, public agencies and insurance companies.
23. Oversees patient related correspondence and complaints.
24. Provides input and review of contracts for carriers and third party payers and makes recommendations.
25. Complete annual performance appraisals for direct reports following CARTI procedure.
26. Complete progressive disciplinary reports and deliver counseling as needed for direct reports per CARTI policy.
27. Participate in continuing education/training activities including monthly online training.
28. Demonstrate ability to handle emergency situations in a prompt, precise, and professional manner.
SUPERVISORY RESPONSIBILITY: Revenue Cycle (including: Patient Services, Patient Access, Billing, Coding, Collections, Precertification, Medical Records, and Cancer Registry.)