Position Summary:

Developing and executing the strategic vision for The Guthrie Clinic's revenue cycle functions. Reports to the AVP, Revenue Cycle. Challenges assumptions and standards of business in an effort to improve overall operational effectiveness and service to The Guthrie Clinic's customers. Providing leadership and oversight of key operational and financial decisions pertaining to all back-end revenue cycle operations. Promoting patient satisfaction.

The Director of Revenue Cycle Management Operations (RCMO) leadership role is responsible for managing all aspects of the corporate revenue cycle hospital and provider based billing for TGC. This position requires a strong blend of strategic thinking, operational excellence, and team leadership skills to ensure accurate and timely billing operations while maintaining a high level of customer satisfaction. Director RCMO, provides leadership to staff and ensures all functions and staff follow applicable Guthrie policies and procedures, quality standards, contractual obligations and applicable laws and regulations. Interacts with clinical and business leaders across the organization to ensure optimal financial and patient experience results.

Education, License & Cert:

Bachelor's degree from a recognized college or university.

Master's Degree from a recognized college or university in Health Care Administration or Business Administration preferred. In lieu of a degree, at least 10 years in healthcare billing or health care operations with focus on revenue capture, charging and/or recovery.

Experience:

• At least five (5) years of management experience in billing, operations or denial related functions within a progressive healthcare environment.

• Revenue Cycle operations experience including knowledge in pre-authorization, pre-admission processes, denials management, claims adjudication, etc.

• Revenue Cycle business process optimization experience including knowledge of edits, denials, holds, reimbursement, etc

• Previous experience using or implementing Epic preferred.

• Advanced knowledge of UB-04, 1500, EOB interpretation, CPT and ICD 10 codes

• Knowledge of various types of health insurance and other third-party reimbursement, health care billing practices, automated billing and accounting systems, collection laws and techniques on working with debtor’s ability to meet payment obligation

• Excellent written, verbal communication and interpersonal skills.

• Time management and organizational skills.

• Self-directed with the ability to work with various stakeholders and teams.

• Ability to make quality, independent decisions as well as the ability to collaborate effectively to make decisions with other leaders.

• Superior analytical and problem solving skills.

• Ability to work effectively and efficiently under tight deadlines, high volumes and multiple interruptions.

• Proficiency with Microsoft Office (Word, PowerPoint, & Excel.

• Member of a revenue cycle transformation effort where key functions were reviewed for standardization and centralization.

Essential Functions:

• Responsible for the corporate hospital & provider based entity revenue cycle accounts receivable including strategic and tactical recoveries

• Establishes standards and processes to ensure continuous improvement in the revenue cycle by developing and implementing changes & enhancements timely and strategically driving transformation

• Responsible for denial management & follow-up, and must be effective in implementation of financial improvement strategies that generate recoveries meeting or exceeding recovery goals.

• Lead the establishment and implementation of KPIs for revenue cycle operations. Responsible for measurement and reporting of ongoing financial and operational performance. Ensure the implementation of action plans where performance is not meeting expectations. Review KPI expectations annually and adjust appropriately. Recognize areas of excellence.

• Manages relations with payers and providers to generate high reimbursement rates and a low level of denials.

• Collaborates with others to ensure reconciliation for revenue, cash, contractual allowance, bad debt, write offs, recoveries, un-posted cash, cash deposits, and all other adjustments.

• Maintains a high-level expertise of healthcare finance, government and commercial reimbursement programs, managed care as well as state and local reimbursement programs. Collaborates with all levels of the health system, including financial leaders, executive management, and vendors to ensure financial and operational goals are met within a cost-effective, efficient manner.

• Optimize billing, revenue collection and direct department operations to ensure that financial, quality, and customer service goals are met.

• Support, oversee and manage the performance and productivity of the staff, utilizing pre-defined goals while providing appropriate feedback and guidance to the billing/ patient liability and customer service teams.

• Ensure that activities are in compliance with applicable policies, standard operating procedures, and standardized practices. Such activities may include billing, insurance issues, and referring accounts to external vendors, among others.

• Provide oversight for vendor activities related to accounts receivable and customer service.

• Ensure that managers / supervisors provide timely feedback to department staff regarding people’s performance, quality, and training requirements including necessary training. Drives a culture that reflects TGC mission, vision and values.

• Participates in the development of department budgets and ensures that department operation objectives are achieved within the budget. Maintain efficiency in capacity planning, FTE costs management per location.

• Serve as The Guthrie Clinic subject matter expert for revenue cycle billing functions and actively research and understand latest industry and market trends, leading practices and technologies.

• Acts as a revenue cycle leader for system conversion, purchases and divestitures.

• Create a collaborative and conducive work environment for employees & colleagues through team building, coaching, constructive feedback, work delegation, personal example and goal setting that encourages creativity, open dialogue on work issues, professional growth, and a consistent, high level of performance. Encourage and support employee decision-making within their scope of responsibilities.

• Participate in and, where appropriate, lead cross-functional revenue cycle projects. Engages with senior management and department heads to align operational delivery and financial management with short & long term planning and projections

• Complete any duties and special assignments as requested.

Other Duties:

1. Educating the team on functionality or workflow.

2. Remaining current with industry standards and events that may significantly impact reimbursement.

Joining the Guthrie team allows you to become a part of a tradition of excellence in health care. In all areas and at all levels of Guthrie, you’ll find staff members who have committed themselves to serving the community.

The Guthrie Clinic is an Equal Opportunity Employer that welcomes and encourages diversity in the workplace.

The Guthrie Clinic is a non-profit, integrated, practicing physician-led organization in the Twin Tiers of New York and Pennsylvania. Our multi-specialty group practice of more than 500 physicians and 302 advanced practice providers offers 47 specialties through a regional office network providing primary and specialty care in 22 communities. Guthrie Medical Education Programs include General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology and Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for the Geisinger Commonwealth School of Medicine.