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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview

Under the general direction of Revenue Cycle leadership, provides organization direction for Hospital Billing to ensure timely billing, collection and cash posting of all hospital charges from all payors. The Senior Manager assists the Director in establishing the organizational priorities and operational strategies to drive optimal performance of the Hospital Revenue Cycle. The PFS Senior Manager acts as a liaison between PFS operations and other departments in the organization. This position provides assistance to the Director to ensure that the organization is performing and delivering against the agreed upon service levels in the organization. The Senior Manager is responsible for the department's overall cash, accounts receivables, write-offs performance and, achieving and meeting KPI expectations. The Senior Manager is responsible for vendor management to ensure vendor contractual agreements are being executed, ensuring performance metrics and optimized to increase cash collections and reduce overall cost to collect.

The Senior Manager must have a clear understanding of the overall organization and the "clients" that PFS operations serves. To effectively lead the department, the Senior Manager must have a strong working knowledge of the operational details, process issues, barriers and opportunities and must possess the creativity and motivation to drive change, realizing maximized reimbursement and minimized financial risk to Stanford Health Care. Successful oversight will result in increased net revenue and lower cost to collect. The Senior Manager serves as a resource to managers, department and hospital staff in all hospital revenue cycle related issues.

Locations

Stanford Health Care

What you will do

• Management and Leadership

• Provide leadership, direction and guidance; Set departmental goals and priorities and assign management oversight for the daily office operations.

• Monitor daily operating activity of department; conduct daily huddles with staff to review department performance and goals and make necessary adjustments in work assignments

• Manage the performance and work products/services of staff.

• Direct managers in developing and implementing short- and long-term work assignments and objectives for staff. Develop guidelines for prioritizing work activities, evaluating effectiveness, and modifying activities as necessary.

• Review and drive improvements in Revenue Cycle ensuring financial obligations are met in accordance with SHC policies and procedures.

• Utilize feedback and needs assessment tools to understand internal customer expectations.

• Strive to provide service that exceed expectations and work to eliminate barriers to good service. Maintain relationships with all internal applicable parties, third party payers, and other agencies, as appropriate.

• Serve as a liaison to key department and clinic contacts to ensure that PFS is meeting service levels and to address issues that may cause challenges to meet service levels and KPIs.

• Work collaboratively with hospital and IT departments to drive organizational efficiencies and alignment and to ensure processes and systems are standardized and optimized for efficient and effective flow of accounts within the department and the organization.

• Maintain a complete record of current policies and procedures followed by staff in department; Responsible for maintaining complete knowledge of the revenue cycle and patient flow including steps taken by staff to complete these procedures; assists supervisors in understanding/implementing and adhering to department and organization policies and procedures

• Identify areas of opportunity to apply process changes and/or technology implementation/updates to optimize PFS performance.

• Manage implementation of standards and systems to enhance quality, consistency, efficiency, and timeliness of responsibilities for the enterprise; designing, develop, and monitor performance improvement processes (e.g. quality, accuracy, productivity and timeliness); identify continuous improvement opportunities and manage productivity metrics and efficiencies

• Represent the department on various committees and attend administrative meetings committees as requested.

• Participate in professional development activities and maintain professional affiliations.

• Identify revenue cycle issues and provide leadership for root cause analysis and problem resolution.

• Maintain detailed understanding of all systems including electronic health record, hospital billing systems and other business systems including system functionality, workflows, and reporting; proactively identify areas for improvement and engage with Information Technology and Revenue Cycle leadership to make necessary changes.

• Manage multiple projects in a timely and efficient manner.

• Conduct special projects and studies as directed; perform other related and incidental duties as needed or assigned.

• Staffing and Development

• Ensure that functional areas of responsibility are staffed appropriately, assist in organizational changes and planning as necessary

• Interview, select, hire and maintain competent and performing staff

• Assure that management is adequately supported, trained and consistently meets competency requirements and levels Supervise, train, orient, coach, develop and evaluate performance over assigned personnel; initiate corrective actions to improve performance deliverables and/or resolve issues as they arise, recommend promotions or implement corrective/disciplinary actions as necessary.

• Foster a success-oriented, accountable environment

• Participate in regular huddles throughout PFS

• Conduct regular unit staff meetings;

• Conduct and report on monthly productivity/quality assurance audits.

• Encourage ongoing staff development and growth. Develop individual staff goals and training plans.

• Ensure that personnel management is handled timely including evaluations, issue resolution, employee labor relations involvement and disciplinary action. Serve as escalation contact as appropriate.

• Regulatory

• Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements.

• Keeps up-to-date on all regulatory and accrediting agency requirements, including Federal and State regulations and Joint Commission standards as they relate to billing, follow-up, remit posting and payment variance. Ensures compliance with policies and directives issued by Medicare, Medicaid, Third Party Payers, and others as needed.

• Maintains knowledge of and complies with established policies and procedures including government, insurance and third-party payor regulations.

• Assures compliance with the medical staff bylaws, rules and regulations, and hospital and departmental policies and procedures.

• Ensure adherence to all aspects of state, local, and federal Billing Compliance policies

• Maintain and enforce patient / client / employee confidentiality

• Operational

• Provide overall direction and supervision to the billing, follow-up, collection, and resolution of all payor accounts; direct the day-to-day activities of insurance claim editing and billing, insurance follow-up, denial and appeals

• Serve as a contact/resource to other departments and clinics for information on payor guidelines, policies and procedures; updates staff and outside departments on government (Medi-Cal/Medicaid/Medicare/VA) regulations and non-government payor medical and billing policies.

• Serve as escalation point to external stakeholders related to billing, follow-up, cash posting, payment variance and/or provider enrollment;

• Ensure that workflows are operating optimally to meet organizational KPIs and ensure timely reimbursement with minimal revenue leakage; monitor backlogs, identify root cause and implement corrective measures as necessary.

• Review current status of patient accounts to identify and resolve billing and processing problems in a timely manner.

• Set goals and implement measurement and tracking to ensure goals are met for delinquent AR, cash collections, denials and controllable write-offs

• Solve difficult payment and associated payor problems (e.g. denials). Audit problem accounts.

• Monitor charge or payor patterns or trends in payment variance and communicate to external stakeholders as necessary

• Provide regular updates to external stakeholders and Revenue Cycle leadership on payor variance and net revenue performance

• Ensure that cash posting processes meet treasury and accounting practices and policies; support audit activities as necessary

• Maintain working knowledge of the Epic payment posting system and perform ongoing training to staff as needed.

• Understand enrollment functions that support appropriate payer contracting and claims adjudication

• Work closely with contracted vendors to ensure vendor contractual agreements are being executed and optimized to increase cash collections and reduce overall cost to collect.

Education Qualifications

• Bachelor's Degree from an accredited college or university Required

Experience Qualifications

• 7+ years to 10 years of progressively responsible and directly related work experience Required

Required Knowledge, Skills and Abilities

• Excellent verbal and written communication skills, including effective reporting of operations, issues and performance

• Excellent people skills, with an ability to partner with a dynamic leadership team and navigate enterprise politics and matrixed relationships

• Demonstrated experience as a team leader; leading teams to generate a vision, establish direction and motivate members to achieve established goals

• Skill in planning, organizing, delegating, and supervising.

• Skill in evaluating the effectiveness of existing methods and procedures.

• Skill in problem solving.

• Ability to manage in complex environment

• Ability to develop long-range business plans and strategies

• Ability to foster effective working relationships and build consensus

• Ability to mediate and resolve complex problems and issues

• Ability to provide leadership and influence others

• Ability to recognize and analyze the impact of regulatory changes on the financial performance of professional revenue

• Ability to read, interpret, and apply policies and procedures.

• Ability to set priorities among multiple requests.

• Ability to interact with patients, medical and administrative staff, and the public effectively. Knowledge of accounts receivables and reimbursement management

• Knowledge of CPT, ICD10 coding and medical terminology

• Knowledge of government program regulations and compliance requirements as they relate accounts receivable management

• Knowledge of information system and software relating to accounts receivables management and billing; Knowledge with EMR and practice management systems. Epic Certification a plus

• Knowledge of local, state and federal regulatory requirement related to the functional area

• Knowledge of principles and practices of organization, administration, fiscal and personnel management

Physical Demands and Work Conditions

Blood Borne Pathogens

• Category II - Tasks that involve NO exposure to blood, body fluids or tissues, but employment may require performing unplanned Category I tasks

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $60.92 - $80.73 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow.

As part of our spirit of discovery, we also leverage our deep relationships with luminary Silicon Valley companies to develop new ways to deliver preeminent patient care.

Learn about our awards (https://stanfordhealthcare.org/about-us/awards.html) and significant events (https://stanfordhealthcare.org/about-us/our-history.html) .