Plans, organizes, controls, standardizes and directs Partners’ billing and revenue integrity strategy, operations and revenue cycle. The role provides the leadership, direction and decision making required to manage pre, during and post billing activities, regulatory adherence, monitoring and education for Partners’ departments. This role will work closely with all departments, hospital and physicians to support compliant billing and optimize patient experience and collections.
Routinely monitors, measures and improves performance metrics necessary to meet established goals. Sustains most up to date internal and external requirements to operate the professional fee-billing unit through supporting compliant billing, staff development and technology updates.
Establishes, enforces and ensures standards of performance and behaviors, monitors and analyzes service standards for billing, revenue integrity, insurance follow-up, patient and insurance collections, reporting and account resolution.
The position is responsible for adhering to and creating structures, policies, guidelines in coordination with Partners’ leadership, as well as driving business strategies, analysis and outcomes.
Understands and supports internal and external relationships including I.T., Finance, Legal and Compliance, as well as vendor relationships to ensure optimal revenue transactions.
- Directs unit activities and operations ensuring timely, accurate and customer friendly services, as well as setting goals using industry benchmarks to drive best practice performance. Meets with leadership and staff weekly to ensure successful department operations.
- Implements and sustains routine auditing processes and reports findings as appropriate. Identifies billing errors and follows-up with staff members/third party payers to ensure resolution.
- Develops, implements, and publishes scorecards capturing key performance indicators.
- Conducts analysis of statistics to help identify and implement remediation plans.
- Actively manages technology and vendor performance, outcomes and relationships ensuring expected outcomes are met and/or real time decisions to ensure best practice performance.
- Develops and implements risk assessment tools to identify areas of potential liability related to professional medical record documentation practices, charge capture mechanisms, coding efforts and billing activities.
- Develops and implements clinician-training programs where necessary in areas such as procedural documentation practices, compliance with teaching physician rules, and a control plan to sustain such practices.
- Oversees the development of educational tools to assist providers in documentation efforts, specifically targeting challenging areas for billing compliance.
- Recommends modifications to overall billing compliance efforts to enhance effectiveness. Establishes goals and objectives for the unit; develops policy and practices, procedures for compliance and auditing activities; directs and controls both the technical and administrative functions.
- Preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.
- Updates job knowledge through educational opportunities; reading professional publications; participating in professional organizations.
- Identifies opportunities for process improvement and automation by recognizing issues based on changes in patient inquiry trends. Provides timely feedback to peers in operational areas and leadership to improve revenue cycle processes. Participates in process improvement initiatives throughout the entire revenue cycle operation.