Patient Financial Services Manager - Program Management II

Manager Of Patient Financial Services

The purpose of this position is to serve as the Manager of Patient Financial Services for Colorado's two Mental Health Hospitals in Pueblo and Fort Logan. Responsible for oversight and management of all revenue and billing activities assigned to the Department of Human Services Mental Health Hospitals, including recording and collecting of revenue in CORE, Colorado's financial system, pursuant to Colorado State Statutes for patients admitted to the hospitals. Responsible for the determination of payment liability for patients sent to outside acute hospitals, monthly reconciliation of revenue with analysis and reporting. Other duties include:

• Unit supervisor for 10 staff members, including direct supervision of 3 individual units: Medicare/Other Insurance, Medicaid/Self-pay, and Audit, including 3 professional staff, 6 technicians.
• Develops performance plans and evaluations; approves performance plans and evaluations; administers corrective actions; initiates disciplinary actions; approves leaves; assigns work schedules; resolves informal grievances; establishes acceptable work standards; sets priorities; initiates hiring process; interviews possible applicants; recommends hire, promotion, or transfer.
• Oversee, direct, and serve as the subject matter expert for all operational activities within Patient Financial Services for both State Mental Health Hospitals, including: interpreting rules and regulations as they pertain to patient benefits and revenue for the Hospitals, Medicare, Medicaid, and Fiduciary Duties.
• Interprets, analyzes, and keeps apprised of current and proposed reimbursement regulations, statutory requirements, and legislation that may affect reimbursement.
• Represent the Division and/or Agency as assigned in providing expertise in patient billing and revenue issues, or any other matters as assigned.
• Responsible for revalidating Medicare and Medicaid enrollments and updating them when changes occur.
• Provide expertise, guidance, direction, and training to Patient Financial Services personnel. Communicate internal and external goals, process changes, and roles/responsibilities to employees. Formulate and implement new processes and improvements to workflow and problem resolutions.
• Schedule and assign workload at the department and functional unit levels, establish and review acceptable work standards and expectations for staff. Provide project support to managers to meet state, department, and internal objectives.
• Direct management of the full revenue cycle, including compliance, claims, denials, collections, and bad debt mitigation, as well as hands-on revenue recognition in the financial accounting system (recording of revenue, managing receivables, cash receipts, bad debt, bad debt allowance, and debt forgiveness in the financial accounting system). Duties also include related general ledger reconciliations and analysis of the patient ledgers (created from claims, cash receipts, and outstanding receivables) to general ledger reports (summarized data from the accounting software)
• Position is exempt and may be required to work in excess of 40 hours per week to complete assigned duties, meet deadlines, or as requested by supervisor.

Revenue:

• Report the financial status of the Mental Health Hospitals at Pueblo and Fort Logan to the Department of Human Services management by monitoring, analyzing, and projecting patient revenue, and by collecting financial and clinical information to track current trends that could impact revenue and ensure compliance with legislative appropriations.
• Explore all sources of reimbursement, thoroughly pursue all avenues of appeal, and appropriately apply the Ability to Pay (ATP) procedures.
• Review patients' personal funds by acting as fiduciary or personal representative in order to ensure that patients do not unnecessarily become ineligible for benefits, thus protecting patient assets in accordance with all governmental and statutory requirements. This may include meeting with patients, patients' family, and/or hospital staff to discuss and provide guidance for financial issues that may arise.
• Represent the Colorado Department of Human Services as a witness in estate, bankruptcy settlements, and court hearings regarding claim appeals and debt collection proceedings to ensure the Department gets appropriate reimbursement for provided services.
• May be required to drive a state vehicle to out-of-town meetings to represent CDHS as needed.
• Ensure all patient financial services operations comply with Generally Accepted Accounting Principles (GAAP), accounting and financial reporting standards established by the Governmental Accounting Standards Board (GASB), Financial Accounting Standards Board (FASB), Colorado Fiscal Rules and Fiscal Procedures Manual, Code of Colorado Regulations, policies and procedures of agencies and external organizations, including the IRS, Office of the State Auditor, Office of the Attorney General, Centers for Medicare and Medicaid Services policies and procedures (CMS), and Office of the State Controller.

Audits:

• Responsible for Patient Financial Services' annual State Financial Audit, financial components of program and performance audits, CDHS Internal audits, fiscal fraud audits, or audits of external entities for Patient Financial Services processes and transactions.
• Responsible for preparing variance analysis documentation and explanations, developing audit finding responses, creating and implementing internal controls, policies, and procedures to comply with audit recommendations.

Other Duties As Assigned:

• Any other duties that may arise in the course of performing duties of this position that aren't covered in the above duty statements.

Minimum Qualifications, Substitutions, Conditions of Employment & Appeal Rights:

Experience Only:

Nine (9) years of relevant experience in an occupation related to the work assigned to this position

Or

Education and Experience:

A combination of related education and/or relevant experience in an occupation related to the work assigned equal to nine (9) years.

Special Qualifications: Required in order to be considered for the position

• Required knowledge and experience in Health Care Provider reimbursement methodologies, including but not limited to: Capitation, Fee For Service, Per Diem, Case Rate, Stop Loss, Percentage of Billed Charges, and working knowledge of various healthcare codes (CPT, DRC, HCPC, ICD, Revenue, and others).
• Extensive understanding of Accounting principles, entering Journal Entries and interactions on the general ledgers, and revenue reconciliation.

Preferred Qualifications:

• Experience in Accounting, Healthcare Billing, Revenue Reconciliation, Booking/Recording Revenue, and AR collections.
• Education in Healthcare Admin, Accounting, or Finance.
• Experience in extracting and analyzing financial data; proficiency in using Microsoft Office (Access, Excel, Word, and PowerPoint); and experience in financial and accounting information systems.
• Preference will be given to candidates with experience in: Electronic Health Record, CORE, and any previously used state Financial systems.
• Previous State Experience.
• Experience with Avatar and CORE.
• Familiar with patient billing, Medicare/Medicaid rules and regulations, Colorado Revised Statutes related to billing and the Institutes, Social Security Administration rules and regulations, and experience with supervision.
• Ability to communicate with patients, their families, etc.
• Proficient with Microsoft Access.
• Proficient with Microsoft Word.
• Previous State experience

Conditions of Employment:

• Full background check and reference check required
• This position requires State of Colorado residency at the time of application (unless otherwise identified in the posting), and residency within the state throughout the duration of employment in this position.
• Motor Vehicle Check
• Must possess a valid, non-restricted Colorado Driver's License or a non-restricted U.S. Driver's License for positions within 30 miles of the CO state border
• Out-of-State Driver's License holders must obtain a valid, non-restricted Colorado Driver's License within 30 days of the employment start date.
• Travel: Occasional travel is necessary to attend training, using a state fleet vehicle
• Other: TB Testing and any other vaccinations required by the State of Colorado May be required to work in excess of 40 hours per week to complete assigned duties, meet deadlines or as requested by supervisor.
• Former State employees who were disciplinarily terminated or resigned in lieu of termination must:

1. Disclose that information on the application.
2. Explain why the prior termination or resignation should not disqualify you from the current position.
3. Provide your employee number from your prior State employment. Absent extraordinary circumstances, prior disciplinary termination or resignation in lieu of termination and failure to provide this information will disqualify the applicant from future State employment with CDHS.