DIRECTOR OF PATIENT HEALTH SERVICES REVENUE

About Whitman-Walker

Whitman-Walker envisions a society where all persons are seen for who they are, treated with dignity and respect, and afforded equal opportunity to health and wellbeing.

Through care, advocacy, research, and education, we empower all persons to live healthily, love openly, and achieve equality and inclusion.

For over 50 years, we have been meeting the needs of our communities with the endless dedication of our diverse teams.

Job Summary

The Director of Patient Services Revenue reports to the Vice President for Access and Strategic Initiative and with their team, has a unique opportunity to serve as a hands-on director for a busy federally qualified health center (FQHC) serving DC's diverse metropolitan area through its robust integrated care team model.

The Director manages the activities of the patient health billing department to promote strong day-to-day billing operations internally and with our external billing vendor, cultivate and nurture strong working relationships, and maximize reimbursement in a cost-effective manner that is following federal, state, and payer-specific billing requirements for patient services.

This role prepares, analyzes, and maintains key revenue metrics and payer revenue performance indicators, ensuring that they reflect best practices and all aspects of operations and workflow to promote the ability to effectively process all encounters to maximize revenue and claim-based quality measure, value-based contracts.

Core Whitman-Walker Primary Essential Duties :

• Performs and behaves in accordance with Whitman-Walker's mission, cultural norms, and core values of dignity, respect, affirmation, and humility.
• Maintain a respectful, non-judgmental, and compassionate manner with patients / clients / staff.
• Demonstrate excellent customer service by identifying and exceeding customer requirements.
• Adhere to Whitman-Walker policies and procedures, with special attention given to HIPAA requirements.
• Maintain data integrity through conscientious use of relevant tools and employing a system of checks and balances.
• Demonstrate organizational skills necessary to multi-task, meet deadlines, and re-prioritize as needed.
• Participate in organizational quality and performance improvement activities.

Role Specific Primary Essential Duties :

Oversee and Manage Revenue-Cycle and Billing Department Operations :

• Manages all activities of the patient health billing department to promote strong day-to-day revenue cycle operations internally and externally, cultivate and nurture strong working relationships, and work to maximize revenue for patient services.
• Works collaboratively with other Whitman-Walker managers and directors to support them in strong coding and documentation and workflow to promote clean claims and maximize revenue.
• Proactively monitor trends on claims and payer issues impacting revenue and manage account receivables to be as low as possible and support the internal billing team and external billing vendor to work all claims to completion and target efforts to reduce processing time and maximize revenue.
• Oversee and manage departmental revenue cycle work to include a consistent approach to monthly close, closely monitoring, and proactive follow-up on claims over 30, 60, 90, and 120 days to reduce processing time and get them paid, focusing on A / R by payer and service area and solving any barriers.
• Tracks all issues impacting revenue or creating delays in payment as well as patient feedback to ensure department, external billing vendor, and managers / directors understand what issues have been identified and steps being taken to resolve the issues.
• Responsible for improving patient health billing revenue by analyzing the full organizational billing cycle, including revenue cycle practices and billing practices, and utilization of EHR (including set up, upgrades / migrations, and monitoring of tools within the EHR) by analyzing and reporting on collections, accounts receivable, and ways to bridge the gap between the operational and clinical sides of the patient health revenue cycle and promote the ability of an organization to handle all health claims effectively.

Team Management and Leadership :

• Manages the recruitment, selection, training, and development of PHB team and fosters communication, collaboration, and accountability within the team to meet the highest levels of customer service, ethical conduct, compliance, and performance of all revenue cycle activities.
• Sets clear expectations, monitors outcomes, creates a culture of open and responsive communication, helping team members solve complex problems and achieve personal and departmental goals through individual supervision coaching, and team collaboration.

Fosters Collaboration and Partnerships :

• Partners across teams to provide training and technical assistance to staff - PHB, client services and call center, finance, and clinical staff on any piece of the revenue cycle process, procedure, and workflow.
• Serves as a thought partner and supports in executing strategic initiatives for service delivery and revenue generation.
• Nurtures strong working relationships internally and externally with insurance providers and government entities, including Medicare, Medicaid, health insurance carriers, and state and local agencies.
• Oversees patient health services billing performed by external vendors and internal PHB staff, including timely and accurate billing and follow-up on all claims and dissemination of patient statements.
• Supervises PHB efforts to ensure that patient concerns / inquiries related to their balances, insurance coverage, and other insurance-related inquiries are handled in a timely and professional manner.

Builds and Maintains Infrastructure and Strong Operations :

Oversees all patient payment / billing policies and standard operating procedures (SOPs)to ensure timeliness, accuracy, compliance, and documentation of workflow and performance of work.

Where necessary recommends and establishes new policies and procedures to address changes or new regulatory or operational guidance from payers or other regulatory entities.

• Works with other resources to ensure billing policies meet Medicare, Medicaid, and other federal and local regulations, rules, laws, and contract requirements, including protection of PHI.
• Supports and provides the necessary documentation for the annual financial audit, any cost reports for rate setting, and grant-related oversight.
• Ensures that PHB department handles billing-related correspondence, tracking deadlines, responding to requests, and coordinating, as needed with other departments or external contacts.
• Accurately and timely completes EHR maintenance and annual updates, including provider set up, payer set up, fee schedule, and any other needed set up to bill claims timely and accurately.

Maximizes rule engines and technical solutions to streamline operations.

• Ensures that WWH maintains an up-to-date database and key organizational files for all third-party payer contacts, contracts, and vendors.
• Leads contracting with payers and implements contracts - creating and maintaining payer and provider set-up files and in EHR.
• Oversees facility site visits from contracted payers. Ensures all enrollment and re-enrollment requirements are met.
• Oversees NPI registration and coordinates with Population Health & Quality and People Services for prompt internal and external provider credentialing process with all contracted insurance companies.
• Other duties as assigned.

Budget Responsibilities :

• Develops and oversees departmental budget, including processing payments to vendors.
• Oversees patient health services revenue to maximize collections and executive billing best practices.
• Supports leadership in setting an annual budget for patient health billing, including budget assumptions based on historical data and provider capacity and creating resulting revenue projections.

Management Responsibilities :

• Provides structure, strong operational procedures, and focused mentorship in leading the patient health billing department and direct management of internal departmental staff.
• Engages staff in performance improvement activities to continuously improve revenue cycle efficiency performance and patient experience.
• Promotes accountability by setting clear expectations and key performance indicators for internal staff and external billing vendors.
• Primary contact to manage payer-provider representative relationships.

Core Whitman-Walker Knowledge, Skills, and Talents Required :

• Ability to work independently with minimal supervision.
• Ability to manage time and effort to meet strategic objectives and complete work.
• Knowledge of principles and processes for providing excellent customer service, both internal and external.
• Knowledge of all applicable WWH policies and procedures.
• Excellent oral and written communication skills.
• Knowledge of healthcare information systems with the ability to adapt to new insurance eligibility, electronic medical records, and population health platforms.
• Ability to maintain records and information in an accurate, timely and confidential manner.
• Ability to adapt to changes in the service delivery model, re-prioritizing as necessary.
• Flexibility to work various shifts, including afternoon and evening shifts as necessary.
• Flexibility to work within the organization's various locations as necessary.
• Commitment to health equity.

Role Specific- Knowledge, Skills, and Talents Required :

• Strong organization and program management skills with an emphasis on results and process improvement and the use of best practices and performance dashboards.
• Fluency in medical terminology, coding (CPT, HCPCS, and ICD-10+), and revenue cycle process, are required.
• CPC / CCS coding certification, Revenue Integrity, and / or Revenue Cycle Professional certifications or equivalent certifications, are preferred.
• Knowledge of eCW and / or other electronic health records and the billing modules; history of successful implementation of a new EHR or migration.
• Strong skills with EHR setup, maximizing automated features, reporting tools, advanced skills in Excel, and strong data reporting and analytics skills.
• Demonstrated ability to exercise sound judgment and proactively and productively complete deliverables timely with minimal supervision and on time.
• Proven management skills, including the ability to lead and support diverse teams.
• Personal qualities of integrity, credibility, accountability, and commitment to the mission.
• Ability to multi-task, be accessible and responsive, and work effectively and efficiently amidst competing priorities.
• Strong written and oral communication skills, including the ability to explain technical billing and health insurance information in clear and understandable ways and support internal stakeholders who may have limited knowledge of the revenue cycle process.
• Ability to build strong relationships and engage related stakeholders internally and externally on behalf of the health center to develop close, constructive professional relationships that help promote strong operations, efficient workflow, and maximize revenue.

Education and Experience Required :

• A Bachelor's Degree and at least 5 years of relevant and equivalent work experience in the healthcare field serving the LGBTQ community are required to substitute for a college degree.
• 10 years of experience in health care billing and revenue cycle management with 2 of the 10 years focused on billing for a federally qualified health center (FQHC) required.
• Five (5) years of experience working with health insurance access and coverage issues with at least 2 years of experience working with individuals who are HIV positive, members of the LGBTQIA community, and face systemic barriers to care and achieving health equity.
• Experience working with Microsoft office suites, Internet Research, eCW, and other electronic health records and their billing modules, and other technology-driven systems.
• Excellent written and verbal skills and ability to present revenue cycle and payment issues clearly address revenue cycle concerns and maximize reimbursements.
• Written and oral fluency in Spanish or Amharic, is preferred.

Working Conditions :

Working conditions for this position are normal for an office environment. Individuals may be required to work evenings and / or weekends and organize events.

Physical Demands :

• Lifting : No more than 20 lbs. and infrequently.
• Movement : Standing and sitting for long periods.
• Visual : Long periods on computer.
• Concentration : Extended periods of engagement with computer systems where concentration is key to accuracy in data entry.

Intermittent periods of engagement with a telephone system to respond to inquiries where concentration is key to task performance.

Communication : Direct and indirect communication. Written and verbal competency.

The above job description is designed to indicate a general sense of the duties and expectations of this position. It is not to be interpreted as a comprehensive inventory of all duties and responsibilities required.

As the nature of our business demands change, so too, may the duties and responsibilities of this position. You may be required to perform other duties as requested, directed, or assigned.

Whitman-Walker is an equal employment opportunity employer and does not discriminate against applicants, its employees, or former employees based on race, color, religion, gender, marital status, sexual orientation, national origin, age, disability, veteran status, or gender identity.

For accommodation in the application process, please contact Human Resources.