Assoc. Director Revenue Optimization
Supports the VP of Revenue Cycle Operations and Optimization in managing aspects of revenue cycle optimization, including maintaining relationship and monitoring of third-party billing organization and EPIC hosting organization, identifying and implementing revenue optimization strategies, regulatory compliance with third-party insurers (Medicaid, Blue Cross / Blue Shield, etc.), and maintenance of billing and reporting systems. Supports fee schedule, contract review and credentialing activities for managed care contracts.
Management (10%)
- Recruits, retains and develops a diverse and highly qualified staff; provides ongoing performance feedback and maintains a safe and professional work environment.
- Trains or assists in training staff in other departments on revenue cycle related areas (both administrative and program) as needed.
- Evaluates staff in a timely manner in accordance with PPGNY's policies.
- Performs other training and mentoring related duties as required.
Revenue Cycle Optimization and Revenue Cycle Liaison (55%)
Performs analysis of revenue cycle trends and identifies areas of focus to reduce denials and increase overall collections.Performs root cause analysis for areas identified, proposes solutions to achieve overall enhancement of revenue and implements changes.Develops workplans to address billing corrections needed, works closely with EPIC hosting organization to implement automated solutionsCollaborates with third party RCM vendor and health center operations to implement process changes.Collaborates with cross functional teams to ensure alignment between clinical operations and PPGNY billing practices.Tracks adherence to process changes implemented and quantify financial impact.Monitor health centers' adherence to charge reconciliation processes and metrics measured by key performance indicators and work with HC leadership to address issues / trends identifiedEnsure changes within the charge description master (CDM) coincide and are implemented with clinical systemsReview changes in CPT, HCPCS, and revenue codes for accuracy, compliance with applicable billing guidelines, and optimization of reimbursementDevelop, deliver, and revise integrity education and training programs in coordination with clinical operations and leadershipPerform revenue integrity reviews and present findings for corrective actionsMonitoring tools (25%)
Develops and implements reporting tools to identify revenue cycle trends, including root cause of denials.Builds reporting tools to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third-party RCM vendor.Creates reports to monitor the impact of RCM enhancements and ensure compliance with new processes.Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance.Education and Training (10%)
Evaluates the results of the periodic coding audits conducted by an outside agency, and partners with the VP of Revenue Cycle Operations and Optimization and clinical services leadership to provide training and feedback to the clinical providers on their performance and areas for improvement.Actively maintains an up-to-date knowledge base of developments in third-party billing, such as changes in Medicaid reporting requirements. Identifies changes required to department procedures in response to such developments.Responsible for identification of training needs for all registration areas and provide training material working in conjunction with RDO of operations.Maintain up to date knowledge of CMS billing rules and payer requirements to proactively identify policy changesRemain current on payer billing requirementsRemain current on Epic reporting toolsCore competencies
A demonstrated commitment to PPGNY's mission related to bodily autonomy, health equity, gender and racial justiceA demonstrated commitment to learning about and enhancing practices related to racial equity and its impact on healthcare systems.Strong relationship building and communication skills, including an ability to work and build trust across cultural differences related to race, class, age, gender, gender identity and expression, sexual orientation, religion, ethnicity, national origin or ability; and to reflect on one's personal identity with humility.Strong knowledge of data and analytics to ensure good decision making, performance measurement and financial analysis.Ability to work collaboratively in cross-organization workgroups.Customer service and interpersonal skills and the ability to coordinate work with others, both internally and externally, to accomplish tasks.Engages in mutual problem solvingFacilitates continuous process improvementsStrong time management skills, including ability to work in a high distraction environment and to juggle multiple deliverables at one timeStrong project management skills, identifying all steps required to meet a deliverable, key stakeholders, deliverables by other units in order to achieve goals, and barriers to success.Required skills / abilities
InterpersonalExcellent customer service and communication skillsAbility to remain focused and calm in stressful situationsExcellent interpersonal, written and verbal skillsAbility to develop and maintain effective, professional relationships with internal and external stakeholdersAbility to work effectively as part of teamTechnicalProficient with Microsoft Office Suite; Advanced Excel skills including Pivot Tables and V Look UpsDeep understanding of EMR systems; Experience in an EPIC environmentStrong data management and data analysis skills; research oriented with the ability to critically analyze large data setsSubject Matter KnowledgeIn-depth knowledge of Medicare / Medicaid regulations, including billing, coding, and documentation requirements.Strong experience in revenue cycle management and optimizationPrevious experience with Charge Master ManagementExperience with principles of process improvementWork Habits / AttributesExcellent organizational skillsOutstanding time management skills, including the ability to work under deadlineThe ability to produce high quality work in a fast-paced environment with changing and / or competing prioritiesAbility to exercise sound judgment and independent decision-making skillsAbility to produce reliable, high-quality work with minimal direct supervisionAbility to exercise discretion in the handling of confidential informationPossess strong work ethicRequired qualifications
Minimum of an associate degree in business administration, accounting, healthcare administration, or other related degree.10 years of experience related to billing, coding, denial management and underpayment analysisDemonstrated leadership skillsTwo years' experience with EPIC Reporting.Preferred qualifications
Bachelor's degree in Finance or IT related areas of focusEPIC related certifications and reporting experienceCoding certification (e.g. CCS, RHIA, RHIT) or applicable experienceTypical physical demands
Requires prolonged sitting and repetitive tasks including use of a computer. Periodic standing, walking, bending. Requires lifting or moving of up to 15 pounds. Visual acuity sufficient to perform frequent work on a computer screen and review printed reports and other materials. Requires the ability to hear and to communicate orally with others. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets, and will require reaching, grasping, pushing and pulling.Typical working conditions
This job operates in a professional office environment. Potential exposure to communicable diseases and other conditions in a health center environment. Requires flexible schedule and during peak activity periods work in excess of 7.5 hours per day and / or 37.5 hours per week.$135,000 - $155,000 a year
PPGNY's benefits package includes : Generous PTO and holiday schedule Medical, dental and vision coverage options for you and eligible dependents FSA, HSA, Commuter pre-tax reimbursement funds Short- and Long-Term Disability, Free Basic Life and AD&D 401(k) Retirement Plan with Safe Harbor contributions after 1 year of employment
All positions at PPGNY require : Proof of immunization or immunity to certain communicable diseases (including influenza during the flu season and Covid-19) and testing for tuberculosis. These certifications are required by the