Director, Revenue Cycle - Claims Follow-Up (Hybrid)

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Position is responsible for developing, coordinating, facilitating, and implementing policies, short term goals, and long term goals to ensure that billing, collections, payment / adjustments applications, correspondence and refund processing is done timely and accurately for the achievement of department and organizational objectives. In addition, this role is responsible directing and managing physician credentialing and coding education for all practices.

Job Description

Desired Skill Sets :

Must have experience working for a large healthcare system

Must have prior claims follow-up leadership experience

Must have extensive Epic experience

Bachelor's degree in healthcare or finance highly preferred

Prefer director level experience

Strong leadership experience

Ability to lead a large team

Minimum Qualifications

Education : Bachelors degree in Business, Healthcare, or related field, Masters of Business Administration preferred

Licenses / Certifications : (None)

Experience / Knowledge / Skills :

10 years of experience in physician practice management operations, patient accounting, and / or financial services

Strong interpersonal, customer-oriented skills. Must have proven organizational skills with an ability to effectively prioritize present information publicly, and communicate in writing clearly, concisely, thoroughly, and accurately

Must have experience in working with computer software, and be able to demonstrate strong analytical and problem solving skills, decision making skills, stress management skills and time management skills

Must be able to travel to all Medical Group current and future locations

Should have experience working with third party payers to expedite billing and collections

Prior management experience in physician practice management operations, including credentialing, billing and collections required. Experience with EMR systems and software maintenance or software customer service preferred

Principal Accountabilities

Develops, facilitates, and implements policies, procedures, productivity standards and training documents to ensure claims, claim denial appeals and refunds are processed in a compliant and timely manner.

Directs the activities of the Physician Practice PBS staff that manages day-to-day bill hold resolution, provider enrollment and credentialing, unapplied or unposted cash receipts application, coding education and credit balance resolution.

Develops short and long term plan for training staff on practice management system, utilizing all tools available to obtain best practice results for cash collections and low levels of non-contractual adjustments and bad debt.

Directs mid-month and month end charge and collections data to ensure that physician practices are achieving or exceeding productivity and cash collections goals.

Communicates on a regular basis with Director Physician PBS System Applications, MHMD, Contracting, Medical Group operations, and ISD to resolve root causes that create obstacles for timely provider enrollment / credentialing, coding, billing and collections.

Maintains shared drive of physician practice credentialing matrix and keeps System Executive, Physician Revenue Cycle up-to-date with issues and concerns related to timely provider enrollment.

Reviews cash posting applications, unapplied or unposted cash, and all processes related to refunds. Works closing with Finance to ensure that daily cash balancing is done at time of service and that all discrepancies in the cash reconciliation process are documented and resolved.

Participates in the development, preparation, and monitoring for the department budget. Assures that revenues, expenses, contribution margin and FTEs meet or exceed budget; prepares and submits budget and related reports; forecasts and accurately projects expenses; takes corrective action to address negative variances; identifies and proposes capital budget items appropriately.

Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

Promotes individual professional growth and development by meeting requirements for mandatory / continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermanns service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

Other duties as assigned.