Childrenâ��s Hospital of Michigan is an international leader in pediatric and adolescent medicine. Surgical services include general, thoracic, reconstructive and cardiovascular. Imaging technology designed specifically for children provides advanced diagnostic services including Positron Emission Tomography (PET) and MRI. The Childrenâ��s Hospital of Michigan Emergency Department is a verified Level 1 Pediatric Trauma Center and dedicated pediatric burn center. Experts in pediatric critical care, rehabilitation, and neonatal and perinatal medicine provide care for thousands of children every year at Childrenâ��s Hospital of Michigan, Childrenâ��s Hospital of Michigan - Troy and six ambulatory sites.
The Director of Revenue Analysis reports to the hospital Chief Financial Officer and directs the revenue analysis function for the assigned hospital (s). Direct the hospital revenue cycle operations, maximizes process efficiency and reimbursement. Works with Conifer team on process improvement initiatives for patient access claims, billing and payment posting. Responsible for the Charge Master. Assists Chief Financial Officer in oversight of contracts and contract compliance. Identifies the need for policy development and/or revision, defines policies in collaboration with higher level management input, goals and objectives. Oversees or directs the development and/or revision of departmental procedures/protocols. Approves personnel actions such as hires, fires, disciplines, etc. Ensures the timely completion of performance appraisals. Develops current to intermediate goals and measures for area(s) of responsibility. Measures and assesses performance. As requested, assists in long range goal development. Assists in development of and monitors budget for area(s) of responsibility. Monitors activities for and ensures compliance with laws, government regulations, Joint Commission requirements and DMC/Tenet policies. As directed, implements external and internal audit recommendations. Ensures hospital departments achieve objectives for diversity of their suppliers.
Essential Job Duties:
1. Responsible for preparation and completion of eReserve.
2. Responsible for the analysis of eReserve and items/trends that significantly impact net revenue. Responsible for the review and approval of manual adjustments and refunds.
3. Monitors/analyzes AR/Disputes and assists with Bad Debt Initiatives. Monitors and communicates non-reimbursable charges (e.g., ABN not signed, denials, disputes, bad debt).
4. Reviews proposed managed care contracts and identify any issues or concerns with implementation of the terms prior to the contract being finalized.
5. Assists in analyzing data to verify contract terms have been loaded correctly into IMaCs and claims properly adjudicated during and after managed care negotiations.
6. Monitors/reviews billing, A/R and reconciliation for hospital specific contracts (e.g., non-IMaCs, local employer). Works with hospital departments to resolve revenue cycle issues (e.g., orders, charging, Patient Access, DNFB, DNSP, QS, disputes).
7. Works with hospital leadership on revenue cycle issues. Works with hospital related entities (e.g., clinics, universities), if applicable.
8. Facilitates revenue cycle meetings (preparation, facilitation and follow-up).
9. Supports/directs/monitors the following: department head meetings, chart audit meetings, compliance committees, charge master review/updates, pass through invoice retrieval, complex (e.g., â��High $â�� or â��At-Riskâ��) in-house patient meetings, hospital revenue cycle implementation initiatives, internal/external Audit Assistance, engaging legal for collection Issues.
1. Bachelor's degree in Business, Health Administration or related area, or the equivalent combination of education and/or experience.
2. Eight years of experience in A/R management and/or Managed Care contracting and analysis, including experience directing a multi-facility business office
3. In-depth knowledge of hospital and physician billing and reimbursement preferred. Past experience in hospital revenue cycle programs highly desirable
1. Working knowledge in the areas of patient registration, billing, accounts receivables, HIM, managed care contractual terms and requirements, health insurance practices, industry regulatory requirements, business office operations, and industry standards for health care revenue resolution management practices.
2. Financial analysis ability to conduct cost and pricing studies and monitor overall financial performance of revenue cycle improvement initiatives and revenue impact of other pricing policy initiatives.
3. Leadership skills including demonstrated willingness to pursue leadership roles with increasing levels of accountability, comfort with decision- making responsibilities, coaching, teaching and counseling skills, and the ability to inspire and build confidence in others and to forego alliances and garner support.
4. Analytical ability to serve in an advisory/consultative role in determining and/or developing strategies, policies, processes, protocols and methods, frequently in the absence of guidelines or technical assistance, and to evaluate and direct complex systems that foster innovative approaches to procedures/processes associated with patient management and the revenue cycle. Ability to research third party reimbursement regulations.
5. Communication and/or interpersonal skills for contact with internal and external customers/stakeholders to obtain and interpret a variety of information based on knowledge of departmental practices, DMC policies and programs and specific technical and regulatory knowledge. Discretion must be exercised in deciding what and how to communicate. Conflict resolution skills must be exercised where policy issues are concerned both within the functional area and interdepartmentally. Diplomacy, tact and listening skills are required. Ability to read, interpret and write technical materials.
6. Project management skills including the ability to define programs, projects, or process objectives, identify stakeholders and their interests, plan steps, coordinate and allocate human technological and fiscal resources to accomplish goals and objectives in a resourceful yet timely manner.
7. Proficient in the use of personal computer and software applications and programs.
Job: Managers and Directors
Primary Location: Detroit, Michigan
Facility: DMC Children's Hospital of Michigan
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.