Director, Patient Financial Srvs - SBO - Full Time

PFS Director SBO

In partnership with Guthrie's leadership team, PFS Director SBO is responsible for developing and executing the strategic vision for The Guthrie Clinic's patient/guarantor billing and collection functions. This involves managing and coordinating the overall functions of patient/guarantor collection to ensure maximization of cash flow while maintaining patient, provider, and other customer relations. Works closely with administrative leaders, managers, clinical personnel and vendors to ensure effective and efficient self-pay pre-service, point of service and accounts receivables management. Provides direction in managing the activities and functions of analyzing self-pay accounts receivable for collection and aging trends, establishing performance metrics, develops automated and efficient workflows, identifying denial trends that lead to self-pay activity, develops and maintains departmental policies and procedures, establish departmental goals and reports to AVP, Corporate AR Management. Identifies areas of improvement and works collaboratively with appropriate parties for resolution. Directs the management of employees in patient guarantor collection. Maintains advanced knowledge of healthcare and automation of self-pay and bad debt A/R and strives to ensure compliance with federal and/or state laws and regulations.

10 years prior experience in healthcare, insurance or businesses with responsibility and management of billing and patient collection. Knowledge of federal and state debt collection laws and patient billing regulations. Preferred Certifications:

• Certified Revenue Cycle Professional (CRCP) or Certified Healthcare Financial Professional (CHFP)
• Certification in Healthcare Compliance (CHC) or equivalent is a plus

Excellent working knowledge in the area of health care revenue cycle billing, strong medical terminology, collection, negotiation and insurance regulations required.

Advanced customer service, written, verbal, organizational and time management skills are a must.

Proficiency in revenue cycle platforms (i.e., EPIC, Cerner, Medent) Microsoft Office products including Excel, PowerPoint, and Microsoft Word.

Proven ability to train and coach staff and build and lead strong teams to meet performance goals and for project management.

Extensive working experience in managing and directing the work of others along with proven planning and problem-solving skills to perform analysis and reports are required.

Ability to make quality, independent decisions as well as collaborate effectively with other leaders.

Bachelor's degree is required. This requirement may be satisfied through an equivalent combination of education and 10 years prior experience in healthcare, insurance or retail businesses with responsibility and management of billing and patient collection.

Plans and manages accurate patient billing and efficient account collection, which includes developing automated and efficient workflows. Works directly with patient access leaders to establish a pre and point of service collection strategy. Actively engages leaders or areas who are under performing in point of service collection. In addition, develops action plans or assists in identifying areas where gaps exist that cause insurance denials, or patients to be listed as self-pay incorrectly.

Seeks automated solutions for manual workflows to drive efficiency. Develops project plans that ensure timely statement release. Establishes and implements a system or process for the collection of delinquent accounts including bad debt transfer to external collection agency, financial assistance programs, and/or appropriate internal collection follow-up.

Oversees, coordinates, and solves complex billing problems. Coordinates with operational and Corporate Revenue Cycle management to ensure organizational problems are resolved.

Establishes and updates reports, departmental goals, initiatives, and performance metrics to AVP, Patient Access.

Assigns projects in order to support troubleshooting and resolving Undistributed credit issues for self-pay. Coordinate refund and escheatment process.

Responsible for the development and creation of policies and procedures including protocols for rejection follow-up.

Maintains controls for invoice adjustments.

Maintains system or process to respond to Automated Call Distribution (ACD) – patient inquiries in a manner that promotes excellence in customer service. Uses call patterns to detect training opportunities, as well as problem areas that may require training with other departments.

Maintains knowledge of and complies with established policies and procedures including government, insurance, and collection regulations.

Attends meetings and participates in committees as requested. Conducts special projects and studies as directed.

Manages within established budget including annual planning.

Coaches, develops, and builds teamwork with employees. Strives for a tier 1 team and makes the workplace productive as well as ensures transparent and open communication exists up and down the employee/peer spectrum. This includes clear demonstration of Guthrie's Mission & Values.

Actively participates as a team member by supporting decisions, accepting change, managing conflict effectively, and valuing the contributions of others.

Maintains strict confidentiality related to patient health information in accordance with HIPAA compliance.

Participates in professional development efforts to ensure current with health care practices and trends.

Serves as a role model and keeps department focused on processes that result in maximum efficiencies and revenue capture.

Key Performance Metrics include:

• Pre-Service Collection Rate
• Undistributed Credit Days
• Self-Pay Days
• Self-Pay Net Collection Ratio
• Self-Pay 90+%
• Bad Debt %
• Self-Pay Payments Auto Posted %
• Payment Plans Using Auto Pay %
• Self-Pay Credits Auto Resolved %

The director must have a clear understanding of multiple managed care contracts, multiple specialty insurance and billing practices, and exercise professional competency in reviewing patient accounts to maximize reimbursement and minimize financial risk to The Guthrie Clinic. Successful oversight will result in increased net revenues by reducing bad debt from potential write-offs. Interactions will primarily be conducted with both patients, staff, leaders, vendors and the results of efforts will lead to secure payment for open balances. Serves as a resource to faculty, managers, and clinic staff in all patient payment related issues.

Accountable and responsible for analyzing and reducing bad debt.

Exceptional communication skills, ability to explain, advocate, and express facts and ideas in a convincing manner, and negotiate with individuals and groups internally and externally.

Emotional intelligent and tactful in all situations.

Superior presentation skills, able to present in a clear and articulate fashion in front of a variety of constituents.

Committed to a "team approach" and encourages a collaboration process, working effectively with a diverse or multi-disciplinary group to achieve a common goal.

Demonstrated knowledge and understanding of Epic, and Governmental/non-government requirements applicable to patient billing processes.

Demonstrated project management skills including managing multiple projects in a timely and efficient manner. Demonstrated abilities in utilizing Lean/project management protocols for efficient workflows.

Demonstrated analytical, problem-solving abilities, strong organization and decision-making abilities with data, people and situations.

Demonstrated familiarity, knowledge and understanding of relevant Hospital Policies, Practices and HIPAA regulations.

Demonstrated skills and proficiencies of Microsoft Excel, Word, Project or other spreadsheet and/or word processing software.

Work independently with strong follow-up skills to ensure effective and efficient completion of tasks.

Adapts to change plan/influence strategies to the organization's political realities and constraints.

Outstanding relationship management skills, easily build strong and effective working relationships within a climate of trust, inspires cooperation and confidence and is a true consensus builder.

Travel for this position is sometimes required.

Participation in community and employee engagement activities is required.

It is understood that this description is not intended to be all-inclusive and that other duties may be assigned as necessary in the performance of this position.