General Summary

• The revenue cycle is defined as all administrative and clerical functions that contribute to the capture, management and collection of patient service revenue.
• The Sr. Director of Patient Financial Services has the overall accountability for maintaining a properly functioning revenue cycle process as well as to develop and manage its Patient Administrative and Financial Services departments.
• This position serves as a critical component of the UMMS management team and makes a significant contribution to the organization's overall effectiveness. Duties would include project management, leadership in revenue cycle improvement, and personnel/communication skills.

Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. These are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

Financial Responsibilities:

Assists the senior management in managing and directing operations and performance of responsible departments.

a. Development of procedures for the collection of accurate patient information at point of admission or registration to ensure expeditious, "clean" billing and /or reimbursement for the patient services and procedures, as well as policies for collection of admission deposit and compliance reports.

b. Establishes service and financial performance standards, goal, and targets for the Medical Center, Kernan and USH's Patient Administrative and Patient Financial Services departments. Assist in the development of long-range planning and goals.

c. Assists in the identification of key elements which have a direct impact on revenue collections and develop information and administrative systems to capture critical statistics; report information to employee whose performance impact these elements; key elements consider are patient account , balance status, 3808 financial class status , payor rejection rates, census , coder quality and productively.

d. Analyzes the utilization of information systems related to the flow of intra-departmental information and third party payor; recommends enhancements to software and/or hardware, as appropriate with the objective being to improve the lack of information between entitles and that will expedite the performance tracking of registration, billing, collection and medical record coding.

e. Plans and implements the design of a physical facility layout to optimize utilization review, financial counseling, medical record management, in-service training, supervision of work units, and patient administrative service.

f. Determines manpower staffing requirements for the assigned departments; assigns required to maximize revenue within budget allocations.

g. Establishes targets for Gross Days of Accounts Receivable Outstanding (GPRO) projected annual cash collections and uncompensated percentage for UMMC, Kernan and USH.

Manages Patient Administrative Service and Patient Financial Services departments, including all the functions of pre-registration, registration, clinical reimbursement, billing and claims, collections, cash management/reconciliation and supporting financial reporting and analysis.

• Incorporate the facility's values into all business staff development practices and all department activities.
• Develops guidelines and management strategies to achieve the targets for Gross Days of Accounts Receivable Outstanding (GPRO) projected annual cash collections and uncompensated percentage for UMMC, Kernan and USH.
• Secures appropriate reimbursement from third party payors for the services rendered to their clients by UMMC, Kernan, and Specialty Hospitals. Monitors the Admitting and Clinical Reimbursement working relationship to provide denied days feedback on the admission flow process and assists with the improvements for increased authorizations.
• Ensures the billing account protocols for discharged not finally billed, reoccurring, inpatient, outpatient, and late charge rebilling of all third party claims.
• Responsible for the collection of account balances from all third party payors and patients, for services rendered and UMMC, Kernan, and Specialty facilities. Ensures the direction of the Medical Assistance Eligibility team and external vendors in the conversion to Medical Assistance for state and federal reimbursement qualified applicants. Ensures recoveries, projections, and validates outsourced agencies are compliant to HIPPA and the Federal Fair Debt Collection Act.
• Ensures timely cash, contractual allowance, and refund processing, and reconciliation of the same for UMMC, Kernan, and Specialty facilities. Ensures reconciliation to the HIS system for revenue, cash, contractual allowance, bad debt, write offs, recoveries, un-posted cash, cash deposits, and all other adjustments.
• Responsible for all cost center budgetary compliance, month-end reporting, receivable levels (days in AR and aging), and cost center productivity.
• Plan, coordinate, and execute year-end audits with public accounting firms and third-party auditors as they relate to AR operations. Resolve conflicts regarding public accounting firms, third-party auditors, and investigate parties.
• Manage daily staff functions in all areas related to the scope of the manager's responsibility. Participate in the revenue cycle, denial management, and access management work teams.
• Maintains appropriate internal control safeguards over AR records and collection of cash. Maintain compliance standards for providing accurate information on all facility or health system billings.
• Ensure compliance with relevant regulations, standards, and directive from regulatory agencies and third-party payers.

Directs and manages the performance of the various departmental staff through subordinate managers, including hiring, firing, disciplining, training, development, and performance review in accordance with UMMS Human Resources policies and procedures. Ensure that standards of productivity are established and followed.

• Assures appropriate administration of the financial systems and business practices to department and ensures Human Resources policies and procedures are followed by subordinate management staff. Communicate and interprets relevant Medial Systems policies and procedures to staff, as needed.
• Approves departmental hiring training, evaluation, discipline and discharge decisions.
• Participate in the development of departmental objectives and organizational structure.

Demonstrate, through plans and actions, that there is a consistent standard of excellence to which all departmental work is expected to conform.

• Establish standards maintaining a constancy of purpose, focusing on continuous improvement within all areas of influence delivering the highest degree of quality service possible.
• Analyze and resolve problems that effect revenue cycle performance, regardless of whether the problem originates under direct or indirect control.
• Make significant contributions to the organization al financial performance of UMMC, Kernan, and USH through revenue cycle process improvement.

Renowned as the academic flagship of the University of Maryland Medical System, our Magnet-designated facility is a nationally recognized, academic medical center with opportunities across the continuum of care. Come join UMMC and discover the atmosphere where talents and ideas come together to enhance patient care and advance the science of nursing. Located in downtown Baltimore near the Inner Harbor and Camden Yards, you won't find a more vibrant place to work!

Education and Experience

• Bachelor's Degree in Business Administration, Financial Management or an equivalent related field is required.
• Ten years progressively responsible experience in revenue cycle operations of which at least five years should be in Academic Medical Systems Setting or a large centralized business office.

Knowledge, Skills and Abilities

• Comprehensive understanding of the operation of the health Information Management and their role in supporting financial and clinical performance outcomes, Specifically as it relates to the security of illness, APR DRG assignment, clinical documentation , time-lines of billing, as well as The Joint Commission (TJC) and HIPPA requirements.
• Working knowledge in the areas of patient registration, billing, accounts receivable (AR) and Cash Management requirements, Managed Care contractual terms and requirements, health insurance practices, industry regulatory requirements, business office operation, AR and financial reporting technology, wage and hour regulation, basic accounting and industry standards for healthcare revenue resolution management practices.
• Ability to analyze and resolve problems that affect the claim submission process, regardless of whether the problem originates in an area under direct or indirect control.
• Financial management skills, including the ability to financially analyze data for operation, budgeting auditing, forecasting; basic accounting knowledge; AR and reserve analysis, market analysis: staffing and financial reporting skills.
• Proficient knowledge of healthcare fiscal management to enable the established and focused control of account receivable, reimbursement and cash flow protocols is required.
• Knowledge of federal and state Medicare and Medicaid regulations, as well as contractual requirements related to managed care programs is necessary.
• Ability to balance hospital receivable performance by administrating management programs that coordinate admitting, registration , medical record coding, and utilization compliance programs.
• Ability to direct a large multidiscipline staff through subordinate management personnel to achieve integration of performance standards. Ability to create, develops, and implements staff in-service educational programs.
• Highly effective communication skills are requirements to ensure satisfactory patient/physician relations are maintained and to communicate with all levels of staff.

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