Senior Director Hospital Billing and Coding

The Senior Director of Hospital Billing and Outpatient Coding is responsible for strategic activities as it relatesto the mid-cycle and back-end patient-related revenue cycle activities for OHSU Health which includes OHSUand all of OHSU system partners both current and future.

• The operational functions under this positions oversight include direction over diagnosis coding and abstracting all outpatient facility accounts inputting charges combined customer service billing to allthird parties follow up with those third parties to ensure payments are received in a timely mannerdenial management payment review cash posting and credit balance analysis and resolution referralto bad debt and the overall operational effectiveness of Hospital Billing and Coding. This position willfocus on revenue cycle operational performance excellence across the system and improving thepatient experience with a focus on cost containment.
• The Senior Director oversees and is responsible for the Epic systems build including claims maintenance and the development of Epic and operational revenue cycle workflows.
• The Senior Director oversees and is responsible for the Huron system and partnerships as related to the back-end revenue cycle.
• The Senior Director will respond proactively to maximize revenue opportunities related to revenue cycle through third party partners and through automation of more efficient workflows. Responsibilities will include creating the best practices in each of the revenue cycle areas above that can be shared and implemented across the system affiliates.
• Critical responsibilities include the achievement of annual and periodic goals for significant statistical indicators of revenue cycle performance that contribute to the financial performance of OHSU and OHSU Health partners.
• The Senior Director will work collaboratively with internal partners in Hospital Financial Services HIS Care Management clinical and ancillary departments and senior leadership to assure compliance with hospital coding billing and reimbursement.
• This position reports to the Vice President of Enterprise Revenue Cycle for OHSU Health and has oversite responsibility for the staff and duties related to the functions described above as well as directing strategic initiatives and enterprise wide performance improvement initiatives to ensure smooth revenue cycle operations that meet the patient care and financial needs of OHSU and OHSU Health partners in a way that demonstrates compassion and service to our patients and their families.

• Leads and directs the Hospital Billing and Coding Revenue Cycle with leadership across the system to carry out comprehensiveintegrated planning for all areas of responsibility with emphasis on strategicinitiatives patient centered processes and continual process improvement.

  • Develop strategic plans that are compatible with the OHSU Healthsmission goals and objectives.

  • Establish and coordinate procedures for timely coding billing posting and collection of accounts to assure positive cash flow and effective management of credit balances. Provide administrative directions to themanagement staff.

  • Establish expectations and plans set priorities and manage processes tomeasure assess and implement improvements to services monitor and report progress towards quality goals on a routinebasis.

  • Synthesize qualitative and quantitative information and identify trendsto keep the cash flow on course.

  • Monitor un-billed reports and work with departments (PAS ITG andCare Management) to resolve issues in a timely manner so not to delaybilling functions.

  • Communicate with third party payors in regard to claim processingdifficulties or new processing procedures.

  • Participate in OHSU and OHSU Health partners system wide front endmid-cycle and back-end revenue cycle denial management and accessmanagement work teams.

  • Maintain a working knowledge of applicable National State and locallaws and regulations the hospital Compliance Program Code of Ethicsas well as other policies and procedures.

  • Participate in Revenue Cycle projects as directed by Vice President ofEnterprise Revenue Cycle.

  • Assist Revenue Cycle Team in staffing managing documenting andcompleting assigned projects.

  • Ensure all assigned department performance appraisals are completedon time.

• Responsible for appropriate staffing of OHSU Health Hospital Billing and Coding positions performance evaluations and recommendation for promotions counseling and disciplinary action. Demonstrate ability to initiate planned change in department due to change in workload schedules or emergency situations that would require reallocation of staff.
  • Provide orientation and training to staff to improve skills and performance.
  • Facilitate innovation and motivate staff to effectively attain operational and patient satisfaction goals
  • Coach staff (represented and management) on technical operation and team behavior issues; champion excellence the customer and collaborative team behavior.

• Create monitor and maintain a positive patient experience.

  • Utilize HFMA Patient Friendly Billing resources to create a consistentand positive revenue cycle patient experience throughout the OHSUsystem.

  • Meet with patient focus groups to understand issues and concerns froma patient perspective. Communicate these issues and concerns toOHSU leadership and work with revenue cycle areas to implement bestpractice changes to provide a better patient experience.

  • Create monitor and maintain revenue cycle patient experiencesurveys. Communicate survey results to OHSU Health leadership andwork with revenue cycle teams to implement possible changes toprovide a better patient experience.

• Effectively communicate with superiors peers subordinates and othersas appropriate on a regular basis assuring proper flow of information.

  • Maintain a direct and open line of communication with Administration through the Vice President of Enterprise Revenue Cycle by providingrelevant information on matters requiring department administrativeaction.

  • Resolve physician patient clinician and interdepartmental complaints and misunderstandings

• Responsible for the departmental budget.

  • Gather feedback from appropriate staff in the development of the budget(S).

  • Consistently operate within budgetary goals in areas of labor and other operating expenses.

  • Prepare monthly analysis of actual expenses as compared to budget.

  • Communicate explanation of significant variances to Vice Present of Enterprise Revenue Cycle each month which includes but is notlimited to plans on staffing staff development and productivityimprovements.

  • Regularly provide productivity updates and reallocate resources as necessary to reduce financial risk and enhance patient experience.

Education:

• Bachelor degree in Business or related field or equivalent combination of education and experience

Experience:

• Minimum of ten years experience in revenue cycle operations
• A minimum of five years experience leading a revenue cycle/billing department in a health system or major hospital.
• Demonstrated knowledge of all phases of patient accounting operations issues challenges and performance metrics.
• Demonstrated record of accomplishment in meeting performance hurdles for improving gross revenue cash collections as well as hitting targets for net days in accounts receivable.
• Record of performance in developing and sustaining performance accountability at all levels within the revenue cycle operations department.
• Record of effective collaboration with other members of the revenue cycle team to ensure success in achieving hospital or system performance targets.
• Track record for successfully making and effectively implementing tough decisions.

Job Related KnowledgeSkills and Abilities(Competencies):

• Exceptional leadership skills with a record of building a strong results-oriented team that excels in a performance-driven environment.
• To provide leadership that will achieve and sustain performance momentum.
• A recognized problem-solver with a history of building a best-in-class department.
• Executive presence with a sense of urgency with performance and process improvement.
• Reputation for attention to details and meeting deadlines with a superior work product.
• Intellectual capacity to assess complicated processes and to devise creative solutions that will enhance performance.
• Demonstrated consistent commitment to effective customer service.
• Effective written and verbal communications skills
• Ability to work in a self-directed manner
• Demonstrated skills in effectively managing political issues and situations.
• Demonstrated record of accomplishment in recruiting retaining and developing managers and staff members.

• HFMA CHFP or HFMA FHFMA
• Masters of Healthcare Administration preferred
• Seven years of progressive supervisory management and leadership in a health system or major hospital.
• Demonstrated knowledge of dealing with potentially complex managed care contracting issues with a record of success in effectively producing appropriate patient bills consistent with the contract

• Standing: As required to make presentations or perform other job tasks.

• Sitting: Chair or stool continuous up to 8 hours per day able to intermittently move about

• Changing Position: Intermittently as needed from sitting to standing to walking etc..

• Walking: Intermittently 2 - 4 hours per day on concrete vinyl and carpeting.

• Carrying: Up to 25 pounds (supplies equipment books papers etc) for intermittent periods anddistances.

• Lifting: Up to 25 pounds ( equipment supplies books etci.) ntermittent throughout the week.

• Pushing/Pulling: Up to 25 pounds intermittent monthly

• Bending: From the waist and knees frequently throughout the day.
• Reaching/Handling: Fine manipulation repetitive gross motor requiring reasonable ROM in upper extremeties including overhead reaching.
• Twisting: Reasonable ROM required intermittent periods throughout the day.
• Climbing: Staircase intermittently throughout the day.
• Crawling: Infrequent but possible on vinyl carpet surface to retrieve or attend to articles that require attention.
• Hearing: sufficient to conduct business via telephone and in-person.
• Speech: speak English to various individuals and audiences efficiently understandably and courteously. Other as expected in a normal office setting