RN CLINICAL EDUCATOR

Overview

Virginia Mason Franciscan Health brings together two award-winning health systems in Washington state CHI Franciscan and Virginia Mason.

As one integrated health system with the most patient access points in western Washington, our team includes 18,000 staff and nearly 5,000 employed physicians and affiliated providers.

At Virginia Mason Franciscan Health, you will find the safest and highest quality of care provided by our expert, compassionate medical care team at 11 hospitals and nearly 300 sites throughout the greater Puget Sound region.

While you're busy impacting the healthcare industry, we'll take care of you with benefits that include health / dental / vision, FSA, matching retirement plans, paid vacation, adoption assistance, annual bonus eligibility, and more!

Responsibilities

This job is responsible for planning, directing and evaluating patient access and patient financial / revenue cycle operational functions / services (clinic and hospital) for the assigned Virginia Mason Franciscan Health (VMFH) market in accordance with overall strategic business objectives, professional standards and applicable regulatory requirements.

An incumbent provides ongoing leadership in assessing, developing, implementing and executing initiatives / programs that facilitate optimal financial performance / productivity, maximize effective utilization of resources, reduce operational vulnerability, strengthen the focus on patient access / revenue cycle accountability and generate a competitive advantage for the organization.

Work involves balancing revenue stream administration with the operationalization of multiple billing requirements and managed care contracts that require exception-based handling.

Assigned functions include :

• Hospital admitting, patient access and patient account services
• Health Information Management, charge review, professional / OR coding, identification of missed revenue
• Provider audits / assessments and appropriate training to maximize revenue and minimize risk;
• Value based contracts
• Access center / ambulatory scheduling, switchboard
• Claims submission; customer service; financial assistance, self-pay
• Cash applications (payment posting, reconciliation, patient / insurance credits / refunds, etc)
• Hospital / clinic insurance billing, follow-up / denials management, auditing and appeals, recovery audit response
• Advanced revenue cycle analytics

Work is performed through subordinate management who are responsible for the day-to-day operations of assigned department(s), ensuring quality and staff productivity standards are met, accurate claims submission, timely resolution of denials / denials mitigation, and maximum revenue is realized within compliant billing processes.

An incumbent participates in long-range planning, budget administration and in the formulation / implementation of systemic and operational approaches, tactics and policies to facilitate achievement of strategic business objectives relating to assigned functions.

• Work also includes : 1) establishing operational metrics, controls and standards, monitoring / auditing on-going operations and adjusting resources / priorities to meet changing conditions;
• 2) managing third-party vendor relationships, providing oversight and guidance as necessary; 3) collaborating with Payer Strategy / Contracting to ensure contracts are optimized for revenue opportunities and that payer contractual commitments are met;
• 4) communicating progress on long-term initiatives / projects to key leadership and other stakeholders; 5) serving as conduit / liaison with various internal / external departments / contacts in coordinating / troubleshooting patient access / revenue cycle-related issues;

and 6) ensuring that automated systems are functioning appropriately and produce timely and accurate results.

An incumbent participates in multidisciplinary teams, working VMFH and CommonSpirit Health (CSH) Leadership / management and external officials / vendors, and requiring the ability to use effective persuasion and negotiation techniques to achieve common understanding, facilitate compromise and arrive at satisfactory solutions to complex issues / problems.

Work requires considerable knowledge of the specialized principles and practices related to healthcare finance / revenue cycle management, including Medicare, DSHS, Third-party payers and other agencies, as well as a comprehensive understanding of coding / charging practices, payer contracting, billing requirements, claims processing, cost structure, patient accounting systems and other interface systems impacting these functions.

Also requires the application of strong communication / change management skills and the ability to work effectively in ambiguous / stressful situations and effectively prioritize multiple changing and conflicting demands / priorities.

Qualifications

Bachelor's degree in Business Administration, Healthcare Administration, Accounting, Finance or other related field, and seven years of progressively responsible related work experience (preferably in healthcare financing, internal auditing, financial management, and / or compliance) that would demonstrate attainment of the requisite job knowledge / abilities, including five years in a leadership / management capacity.

Master's degree in a related field is strongly preferred.

We are an equal opportunity / affirmative action employer.