The LH Executive Director of Patient Financial Services (PFS) is responsible for the management of PFS functions across LH hospitals. This leadership position ensures processes, workflows and staffing infrastructure is standardized (where applicable), and optimized to achieve optimal results in cash collections and industry leading A/R metrics.
Essential Job Duties:
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Ensures timely, complete, and accurate generation, follow-up and adjudication of claims. Ensures all staff and management responsible for are versed in LCD's, CCI edits and all relevant billing rules and regulations and workflow reflects regulatory recommendation. Maintains a clear and consistent claim follow-up workflow to identify, address and mitigate denials.
- Responsible for the PFS denial workflow ensuring the regular and appropriate dissemination of denial work to internal PFS staff, external vendor/attorneys and/or the respective internal clinical staff to address claim denials. Takes an active and actions oriented role in Denials Management work groups.
- Responsible for customer service related to PFS related functions. Maintains frequent contact with internal and external stakeholders to ensure optimal customer service
- Responsible for all PFS related cash management functions ensuring internal controls are in place and all functions within cash application are managed, monitored and optimized. Regularly tracks and trends point of service cash collections to identify areas of opportunity and effectively communicates with leaders.
- Responsible for all payer interactions including, but not limited to, maintaining payer level detail supporting payer advances and performs validation of adjustments to payer advances, ensures timely completion of accreditations/re-accreditations, plays lead role in coordinating interaction with payers to address payment related issues. Escalates issues to senior management, as warranted.
- Regularly evaluates use of third party vendors to support PFS functions and evaluates from cost/benefit perspective. Maintains clear and current vendor summary information including, but not limited to, monthly performance activity by vendor, expenses incurred, and evaluates performance to determine effectiveness of vendor. Makes recommendations for adjustments, and plays a lead role in negotiating with new prospective vendors, as needed.
- Responsible for the cashiering function including the workflow, process and related internal controls.
- Oversees the patient advocacy process to secure applicable coverage for uninsured patients and makes recommendations for continued optimization of performance. Coordinates internal advocacy efforts with external contracted vendors to achieve a comprehensive process ensuring coverage to uninsured patients. Maintains performance information to report on advocacy efforts on regular basis.
- Responsible for the pre-registration and financial clearance function to secure complete and accurate information.
- Oversees the financial counseling function to achieve optimal financial results without compromising patient satisfaction. Continuously evaluates process and approach to financial counseling to ensure optimal patient experience and outcomes.
- Coordinates all PFS related audits and reviews, develops and maintains clear and concise summary information on major reviews (ex: RAC/MAC, etc.). Escalates risks or concerns to senior management in timely fashion with corrective action recommendations.
- Is proficient in Epic and effectively monitors all relevant Epic dashboards to stay abreast of collection issues. Acts as the lead to coordinate Epic related changes to IS counterparts and to ensure all staff are adequately trained and executing on the optimal use of Epic. Oversees Epic (or other PFS related systems) upgrades and modifications in collaboration with counterparts in IT.
- Takes the lead in all PFS related Revenue Cycle and billing compliance related meetings and issues. Is versed in Corporate Compliance issues related to PFS activity and reports any breaches to appropriate leadership Provides historical knowledge and corrective action plans for any issues.
- Develops and maintains positive and effective working relationships with clinical and finance colleagues. Provides subject matter expertise in resolving issues.
- Is versed in all 3rd party issues impacting PFS. Maintains current industry knowledge by participating in professional organizations.
- Is responsible for developing and achieving budget targets including staffing, vendor expenses, and all other budgeted expenses.
- Develops optimal and efficient staffing structures, maintains a focus on continued development of staff and provides on-going training and educational opportunities to staff and management.
- Acts as key resource to clinical colleagues interpreting clinical issues impacting PFS performance. Recommend corrective actions to mitigate collection issues.
Human Resources Management:
- Recruits, selects and retains highly qualified professionals. Provides the leadership necessary to maintain a motivated, productive and competent team through open communication and delegation of responsibilities and authority.
- Establish credibility throughout the organization as an effective problem solver; be viewed as approachable and as a mentor to staff and colleagues.
- Manage assigned personnel including development of performance objectives, assigning and monitoring workload and appraise performance. Coach and develop employees in job related skills through work assignments, direct training, and regular feedback.
- Maintains a professional demeanor in managing people and processes.
- Required Minimum Education: Masters Degree in Business Administration or related field.
- 5-7 years of related work experience at Director level, in hospital setting. Strong knowledge of computer software programs. Excellent verbal and written communication skills. High level of interpersonal skill.
Working Conditions, Equipment, Physical Demands:
There is a reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.
Physical Demands -
The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.
The above job description is an overview of the functions and requirements for this position. This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.