University Hospitals (UH) is a community-based healthcare system which serves patients at more than 150 locations throughout Northern Ohio.
Committed to advanced care and advanced caring, UH encompasses the region’s largest network of primary care physicians, outpatient centers and hospitals. The network also offers specialty care physicians to treat almost every disease and condition, skilled nursing, elder health, rehabilitation and home care services, and occupational health and wellness. University Hospitals is the second largest private sector employer in Northeast Ohio and is within the top five largest private sector employers in the state of Ohio.
Sets, formalizes and executes corporate strategy for revenue cycle business function, controls, transactions and team accountability including Central Business Office (CBO) post claim revenue recovery for technical and professional insurance and patient collections ensuring compliant, accurate, timely and optimized collections and system cash flow of estimated $2.9B. Ensures cost controls meets or exceeds corporate objectives for cost containment.
Plans, organizes, controls, standardizes and directs CBO post claim /revenue recovery functions including insurance follow-up, cash application and credit management, denials management, post payment review, customer service and Remote Hospital Business Office functions. Drives leaders and staff to achieve performance targets and revenue optimization goals for responsible area and enterprise initiatives. Sets and assesses business metrics and challenges status quo driving continuous process improvement. This position oversees 340+ FTEs.
Drives analysis needed to remain current with revenue and reimbursement trends and creates agile work environment needed to achieve established targets and works to exceed industry benchmarks.
Drives standard /effective reporting and relationship management for UH facility and UHPS departments related to RCM outcomes, issues and recommendations for process improvement. Actively monitors performance and supports team ensuring optimal RCM outcomes and service.
Develops, formalizes and enforces standard operating procedures, policies and guidelines governing compliant management of transactions and processes within areas including adherence to internal and external policies and protocols. Remains current with governmental, payer and organizational policy changes.
The role provides daily senior leadership, direction, decision making, and supports management and staff in day including coordination with other Corporate and Operations departments including Finance, UHPS, Patient Access, HIS and other areas as required to establish metrics, enable appropriate standards and requirements and sustain strong working relationships. The role will work closely to support Central Business Office (CBO) leadership to coordinate support and hand offs between Remote Offices Financial Counselors and Self Pay Collections to optimize patient experience and collections.
Leads, promotes and executes in system integration and unification of RCM functions and governance process regarding corporate RCM functions including workflow, policy, physical and cultural integration. Drives, communicates and ensures RCM workflow result in patient centric outcomes optimizing patient access, communication and experience.
Works directly with Finance as the appointed leader for RCM and active member in preliminary and final monthly closing transactions and procedures.
Owns and manages vendor relationships and solutions for designated functions and transactions. Ensures software and integration is current, efficient and staff and leaders are properly trained on usage and reporting.
Oversees Revenue Cycle Management department budget process in concert with RCM senior team.
Establishes, enforces and ensures standards of performance and behaviors, monitors and analyzes departmental service standards for areas of responsibility including setting and administering training standards, timely service and achieving performance goals.
The position is responsible for adhering and creating Insurance and Patient Collection policy and guidelines in coordination with CBO leaders, as well as driving collection strategy, analysis, payment options, financial assistance as well as oversight of patient friendly billing, on line and other technology solutions as well as pre collect, collection and other vendors contracted to optimize patient collections.
Understands and supports internal and external relationships including I.T., Legal, Compliance, Internal Audit as well as vendor relationships to ensure compliant revenue transactions for each remote business office.
Directs corporate department activities and ensures compliant services and operations including ensuring timely, accurate and patient friendly service including setting goals using industry benchmarks to drive best practice performance, cash collections, denials management, post payment review, credit management and customer service.
Meets with leadership and staff weekly to ensure success department operations and help to resolve issues impeding performance. Focuses on consistent achievement of net revenue targets.
Standardizes strategy, workflow, technology decisions, and operations for areas of accountability.
Ensures and sustains routine auditing processes and reports findings as appropriate. Identifies billing errors, and follows-up with staff members/third party payors to ensure resolution reporting with feedback cycles are completed and documented to ensure ongoing improvement in service delivery.
Leads, develops, implements and publishes department score card capturing key performance indicators for each Remote Business Office, as well as vendor performance.
Drives analysis of department statistics, collections, agency performance and bad debt to identify ongoing service and collection strategies for the organization.
Oversees and manages technology and vendor performance, outcomes and relationship ensuring expected outcomes are met and /or real time decisions to ensure best practice performance.
Directs leadership for Remote Business Office human resource objectives by leading and guiding on recruiting, selecting, orienting, training, assigning, scheduling, coaching, counseling, and disciplining leaders and employees; communicating job expectations; planning, monitoring, appraising, and reviewing job contributions; planning and reviewing compensation actions; enforcing policies and procedures.
Meets UH RCM insurance and patient collections financial objectives by forecasting requirements; preparing an annual budget; scheduling expenditures; analyzing variances; initiating corrective actions.
Continuously improves Insurance and patient collection quality results by studying, evaluating, and re-designing processes; establishing and communicating service metrics; monitoring and analyzing results; implementing changes.
Updates job knowledge of self and team, by participating in educational opportunities; reading professional publications; maintaining personal networks; participating in professional organizations.
Works with leadership team to establish staff assessment, training and post training validation programs and ensures adherence requirements.
Identifies and executes on opportunities for process improvement and automation by recognizing issues based on changes in patient inquiry trends. Provides timely feedback to peers in operational areas and leadership to improve Revenue cycle processes based on patient experiences. Participates in process improvement initiatives throughout the entire revenue cycle operation.
Ensures leadership enables staff members are properly addressing cases where patients needing services have no medical insurance (referred to as self-pay). Coordinates staff members and external agencies in assisting patients with obtaining coverage via government programs and the evaluation of charity assistance where applicable.
Ensures leadership and staff members are properly handling all customer service/billing issues and questions, and works with priority patients, insurance companies and/or clinicians to ensure resolution.
Ensures that self and department ensures in-depth knowledge of policies, procedures and laws relating to medical insurance/patient billing and collections.
Ensures that self and department maintains in-depth knowledge of government assistance programs and resolves payment discrepancies that are escalated from the staff.
Acts as Revenue Cycle Management senior leader and liaison to organization and vendors that interact with patients.
Performs leadership and designated leadership evaluations and ensures standardization with the staff evaluation process.
Performs other duties as assigned.
Experience & Knowledge:
• 12+ years progressive experience in healthcare revenue cycle operations including experience hiring, training, evaluating, disciplining, developing and engaging staff members in large/very large department setting required.
• Excellent knowledge of governmental and 3rd party reimbursement structures required.
5 years of Customer Service, practice management and/or hospital administration experience or equivalence preferred.
• Proven track record for achieving industry benchmarks for revenue cycle transactions.
Strong understanding financial transactions including accounting processes.
• Must be customer, provider, and employee focused with exceptional people and service skills.
• Experience with managing escalated customer complaints, and executive level inquiries required.
• Must be detail-oriented and organized, with good analytical and problem solving ability.
• Notable client service, communication, presentation and relationship building skills required.
• Ability to function independently and as a team player in a fast-paced environment required.
• Must have exceptional written and verbal communication skills.
• Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e., printers, copy machine, FAX machine, etc.) required.
• Oracle, Kronos, Soarian, CSC Papers, META, and/or IDX, experience preferred.
*Please send all expressions of interest along with your CV to Rebecca.Pelfrey@UHhospitals.org