Director - Managed Care Insurance Collections - Ancillary Financial Services (AFS) Billing - Maitland
AdventHealth Maitland seeks to hire a Director - Managed Care Insurance Collections who will embrace our mission to extend the healing ministry of Christ.
Established in 1908, AdventHealth is one of the largest not-for-profit healthcare systems in the country, caring for more than a million patients each year. The 2,675-bed acute-care medical facility, comprised of nine hospitals, has been recognized by U.S. News & World Report as one of the best hospitals in the country for over 10 years. It serves as a community hospital for Greater Orlando and as a major tertiary referral hospital for Central Florida and much of the Southeast, the Caribbean and Latin America.
The Director of Managed Care Insurance Collections provides strategic direction for third party payers in the managed care/commercial realm, actively plans, develops, organizes, and manages multiple areas of responsibility as assigned by senior leadership. Strategically designs processes to meet or exceed key performance indicators related to both financial metrics and regulatory compliance requirements. Leads discussions with managed care payers to mitigate risks. Meets goals as outlined by both the Regional VP of Revenue Cycle, the Regional CFO and/or the corporate Revenue Cycle department, which directly manages and contributes to collect an annual net revenue of $3.4 billion. Is responsible for the primary contact with our AHS Managed Care department. Identify key opportunities for performance improvement within areas of responsibility and beyond. Create and manage the budgets for areas of responsibility, while looking for areas of potential improvement. Cultivate leadership development by providing frequent feedback. Mentors staff, manages budget and labor, and meets departmental goals. Analyzes processes and coordinates with leadership and executive team members of various Florida Hospital departments and other service partners to develop policies and procedures mutually beneficial to all respective areas while maintaining the integrity of the PFS Departments. Responsible for managing payer meetings (JOC - Joint Operating Council), AHS Managed Care, Revenue Cycle and Finance Council. Provides appropriate planning to address payer payment issues and creates new ways to mitigate risks. Responsible for providing staff with resources and training in order to aid them in meeting or exceeding all performance goals including but not limited to accuracy, collections, regulatory and forms completion. Actively participates in exemplary customer service and accepts responsibility in maintaining relationships that are equally respectful to all. Adheres to Florida Hospital Corporate Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.
Uses discretion when discussing personnel/patient related issues that are confidential in nature
Is responsive to ever changing matrix of hospital needs and acts accordingly
Proficient in time management with superior prioritization skills
Competence in one or more areas with PCs related programs. Expertise in Excel and Word
Strong organization skills with excellent analytical and problem solving skills
Able to understand business processes or organization. Strives for professional excellence through self-assessment, continuing education and maintenance of credentialed status
Initiates creative approaches to problem solving. Able to coach employees effectively while tapping their potential
Knowledge of contract knowledge which drives net revenue collections
Proficient in the performance of basic math functions, capability of communicating professionally with an acceptable use of English and spelling. Capable of communicating effectively and professionally with our patients and physicians.
Secures business results in the area of FH Extending Excellence model (Team, Clinical, Service, Market, Finance)
Working intermediate knowledge of patient accounting systems as well as back-end and front-end revenue cycle functions and processes (Preferred)
Able to favorable influence team(s) to exceed department goals (Preferred)
Bachelor's degree (business, healthcare or health services administration, health information management, communications, finance, accounting, public administration, human resources, management, or marketing).
Master's degree in Business Administration (Preferred)
Seven years' experience in Patient Access/Patient Financial Services Department or related area
Three years of managed care experience in collections and billing operations
Three years in a management/leadership role
Licensure, Certification, or Registration Required:
Demonstrates through behavior AdventHealth's Core Values of Keep Me Safe, Love Me, Make it Easy, and Own it as outlined in the organization's Performance Excellence Program.
SCOPE OF RESPONSIBILITY:
Actively manages, plans, develops, and organizes multiple areas of responsibility as assigned by Senior Leadership. Practice excellent time management in order to be available to attend meetings for Leadership of all responsibilities.
Oversees the account receivables of all areas of the hospital net revenue operations. Strategically monitors, develops and implement ways to protect the financial stability of the hospital. Supports, develops, and analyzes account receivable reports and provides findings to the Vice President on a frequent bases basis.
Oversees insurance payors to ensure timely, accurate claims submission and claims reimbursement. Reports, analyzes, and monitors accounts receivable for all payors, communicating findings to leadership with status updates or escalation as needed.
Leads development of departmental strategic plans by defining projects, priorities, and actively involved in ROI analyses, vendor selections, banking relationships, payment merchants, agencies and internal audit plans.
Assess and understands business processes of the Revenue Cycle from registration to billing operations. Anticipates needs of the department and pursues solutions. Displays extensive historical and current knowledge of information system technologies and our internal systems to ensure optimum efficiency in department's operations.
Responsible for managing payer meetings (JOC - Joint Operating Council), AHS Managed Care, Revenue Cycle and Finance Council. Provides appropriate planning to address payer payment issues and creates new ways to mitigate risks.
Is active in various meetings within PFS to ensure continued focus and improvements in our patient and insurance collection practices. Participates in Denial Management, Cerner, Contract Management, Agency Tracking, external business partner meetings, and various other high level committees for PFS department.
Assist in the annual review and updating of all policies, SOP's and reference materials pertinent to areas of responsibility.
Reviews and researches insurance and government regulations, analyzing effects on department operations. Communicate changes appropriately and efficiently. If needed, developing plans of action with leadership.
Works in conjunction with Corporate Compliance on all financial regulations to ensure training programs for new and existing staff continues to meet all state and government regulatory requirements. Responsible for providing reports for state audits and regulatory reporting.
Conducts audits of bank deposit correction notices to ensure timely and accurate adjustments to patient and general ledger. Reviews and evaluates various system generated cash reports and prepares analysis of cash posting trends and goals across payers.
Accountable to all departments, service partners and clinical offices for the performance of the PFS departments and serves as point of contact for any unresolved issues or those requiring service recovery measures.
Works closely with Medical and Contract Management as well as PFS to identify issues resulting in potential or actual denials. Responsible to ensure leaders and staff are held accountable for errors and coordinates with leadership to improve processes or reallocate staff to facilitate resolution of issues.
OPERATING & CAPITAL BUDGET/FINANCIAL RESPONSIBILITY:
Create and manage the budgets for areas of responsibility, while looking for areas of potential improvement.
Develop strategies across areas of responsibility to exceed Revenue Management cash projections, reduce days in accounts receivable and denials.
Monitors staffing levels to maintain performance and contribute toward departments key performance indicators while meeting budgetary constraints.
Meets monthly budget goals by managing staff levels that are within set labor standards and limiting use of overtime and providing necessary coverage. Regularly reviews monthly budget and volume reports. Limits use of overtime by monitoring productivity.
STRATEGIC PLANNING RESPONSIBILITY:
Identify opportunities for performance improvement within areas of responsibility and beyond.
Strategically designs processes to meet or exceed key performance indicators related to both financial metrics and regulatory compliance requirements.
Expect results from all direct reports. Set clear, compelling goals for staff and hold team members accountable for performance.
Identify and review new technologies to enhance PA/PFS. Develop strategies to reduce cost of collections across areas of responsibility, to include external business partners.
Creates synergies, maintains bidirectional communication, and acts as point of accountability between PFS and clinical, administrative, and payor partners ensuring open communication and collaboration toward common goals.
PERFORMANCE IMPROVEMENT RESPONSIBILITY:
Provides ongoing education to minimize errors and avoid denials and rejections to direct reports.
Be active in responding to change and opportunity. Actively seek new and improved ways to increase productivity.
Cultivate leadership development by providing frequent feedback. Reviews all A/R reports available, communicates outcomes to team and leadership timely, and provides accurate statistical records and reports.
Meet weekly with Patient Financial Services Administrative Director to review key indicators addressing any areas of concern and plans for resolution
Meet bi-monthly with Patient Financial Services Assistant Vice President to review areas of responsibilities and work together to address any concerns.
Interacts with AHS, Revenue Management Leadership, MIS, FH Accounting, FH Attorneys, bank officials, service vendors, and service technicians to review current and new service opportunities for improving efficiencies, quickly resolve system or equipment issues that may interrupt generation of printed batch bills or timely processing of patient statements.
COMMUNITY RELATIONS RESPONSIBILITY:
Responsible to be on call as necessary for emergencies and departmental assistance.
Advocates team involvement of the Hospital approved community programs, including Backpack for Kids, Adopt-A-Family, American Heart Association's Heart Walk, and United Way.
Adheres to department operation procedures for response to external disaster protocols, which may include disaster childcare relief.
Responsible for ensuring optimal employee engagement scores that meet or exceed hospital goals.
Sets clear, compelling goals for staff and holds self and staff accountable for individual and team goals set by PA/PFS Department. Provides encouragement, education, and training to motivate team members and develops, maintains and manages incentive programs.
Responsible for providing staff with resources and training in order to aid them in meeting or exceeding all performance goals including but not limited to accuracy, collections, regulatory and forms completion.
Ensure timely completion of performance excellence evaluations and consistency in application of departmental policies, including those specifically dealing with progressive discipline.
Regularly meets with and mentors direct reports, (PFS Managers), in day to day management of staff focusing on employee engagement and the servant leader model. Set the climate for open, frequent communication.
Serves as a resource and educator regarding interdepartmental and payor questions. Consistently ensures team members understand the importance of clear and thorough claim reconciliation information in order to maintain a close working relationship with clinical and business partners and provide patients with excellent service.
If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Director - Managed Care Insurance Collections opportunity with AdventHealth Maitland and apply online today.
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.