DIRECTOR-PATIENT FINANCIAL SERVICES

POSITION SUMMARY:

The Director for Patient Financial Services (PFS) directs policies, procedures and work processes with appropriate controls to effectively manage cashflow and accounts receivables and achieve industry-leading Key Performance Indicators (KPIs). Leads Hybrid Work from Home revenue cycle functions in the achievement of Service Level Agreement (SLA) expectations for professional billing services provided for LifeBridge Health providers and Partners. Assigned revenue cycle functions may include charge capture integrity, invoice follow up, EDI and Claims Submission, denials management and treasury/cash Application. The Director also has chief or subordinating responsibility for working with the IT department, AthenaIDX and other vendors to drive efficiencies into all aspects of the operations, including Health Plan set up, TES edits, claims processing, billing and collections and Data Informatics. The Director assists with overall business planning, budgeting, performance improvement, trend analysis, evaluation, and enhancement of the Company's services. PFS professional billing services are performed by Practice Dynamics, Inc, (PDI), LifeBridge Health's medical billing company. Reporting to the PDI Chief Operating Officer, the Director oversees and maintains best-in-class revenue cycle performance that is valued and respected at all levels of LBH.

ESSENTIAL FUNCTIONS:

Directs and Leads: Strategically directs the PDI revenue cycle operations, providing day-to-day supervision, ensuring performance aligns with the LBH/PDI strategic plan.

• Builds, develops team and performs to meet Service Level Agreement (SLA) expectations.
• Leads, coaches, develops and retains high-performing teams that employ best-in-class practices to achieve maximum revenue cycle outcomes.
• Oversees and directs the work of the teams, ensuring ongoing performance management that establishes accountability for efficient work completion and measures both quality and productivity of work completed by associates and by the medical billing company overall.
• Provides guidance and feedback to direct reports.
• Develops goals, objectives, and measurement standards for the departments.
• Manages hybrid and remote work arrangements.
• Manages workload requirements efficiently using available staffing resources.
• Performs ongoing staff quality assessment to assure maximum quality and productivity.

Manages Cash Flow: Leads revenue cycle efforts that achieve cash flow targets and best-in-practice KPIs.

• Defines a clear strategic plan for the revenue cycle function, focusing on ensuring revenue cycle management and operational compliance, that aligns with the Company's strategic priorities, policies and short- and long-term goals.
• Ensures accurate, timely and compliant completion of all processes including invoice follow up, claims submission, posting of insurance and patient payments; collection of outstanding balances to include placement with collection agencies, bank deposits, payment posting and cash reconciliation and appeals management.
• Directs and manages accounts receivable (AR) activities to ensure accounts are collected appropriately and timely from insurances and patients.
• Establishes work priorities and performance expectations for the teams.
• Develops policies, procedures and standards to support effective billing and collection practices.
• Monitors and maintains all patient financial service systems including Enterprise Task Manager (ETM), AthenaIDX EDI services, etc.
• Provides performance feedback and ongoing training to staff to ensure effective collection activities and maximization of ETM.
• Ensures a compliant program is in place for deductions from revenue including contractual adjustments, controllable adjustments, discounts/other write-offs and refunds. Periodically reviews adjustments, write-offs and refunds and specifically approves large balance write-offs to ensure appropriate receivables reduction.

Communication: Communicates regularly priorities, goals, standards, expectations and performance feedback to COO, internal teams, PDI management team, practice and partner leadership and other appropriate stakeholders.

• Establish and maintain effective working relationships with practices, partners and staff. Provide exceptional customer service.
• Effectively communicates team and organizational strategies and goals to team "just in time" or through regular team meetings.
• Timely discusses and resolves operational and individual employee issues that impact quality, productivity, and accomplishment of goals.
• Actively encourages, recognizes and rewards performance improvement and innovation. Tracks the status of previously identified issues and recommendations for improvement.
• Interfaces with billing and practice staff and Information Systems regarding process changes and technology needs. Screens and validates enhancement requests
• Discusses payor issues with staff and assures timely communication of payor and managed care contract information to staff.
• Meets virtually with physicians and practice management staff monthly (or as needed) to discuss revenue cycle performance resulting from functions such as charge lag and billing denials, to identify and resolve billing related operational issues, and to monitor customer satisfaction. Communicates as often as needed to make billing operations run efficiently.

Evaluates and Monitors: Measures and monitors billing performance through establishment and tracking of KPIs.

• Ensure appropriate internal controls are in place.
• Oversee client billing performance on practice and service line basis.
• Identify areas for additional training and improvement; provides solutions.
• To recognize and correct areas for improvement, reviews billing reports to diagnose issues and develops plans for resolution. Provides feedback on results to management and staff. Provides immediate notification to practice management when practice could take action to resolve issues that affect overall performance results.
• Provides problem solving assistance and participates in large department projects.
• Achieves goals identified for but not limited to Gross Collection Rate, Collections, Days Revenue Outstanding, Percent of A/R Balances Aged > 90 and 120 Days, Controllable Write-offs, Bad Debt and Credits.
• Stays aware of and reports factors affecting practice productivity, especially charge performance and determines impact on budget performance; and provides monthly strategic operations reporting regarding success in these areas and plans to attain objectives.
• Maintains billing and accounts receivable metrics at goal for assigned specialties based on practice specific indicators and tracks progress. Monitors provider, practice and PDI performance against goals, identifying and explaining reasons for both positive and negative variances.

Innovation and Performance Improvement: Leverage emerging technologies to streamline revenue cycle processes.

• Establishes best-in-class processes and utilizes existing technology and internal and external resources to drive efficiencies into the Company's revenue cycle practices, enhancing the deployment of new technologies, processes, and data analytics.
• Collaborates with the IT department and external vendors to replace manual tasks with automation through use of agents, bots and other available technologies.
• Leads team performance improvement and problem-solving discussions and financial implementations projects, conducts root cause analysis for complex billing issues and to recognize and correct areas for improvement.
• Using internal and external benchmarking data, leads identification of opportunity areas.

QUALIFICATIONS AND REQUIREMENTS:

• Basic professional knowledge; equivalent to a Bachelor's degree; working knowledge of theory and practice within a specialized field.
• 5-7 years of experience.