Facility: WAB - Wellstar Administrative Building

Job Summary:

The AVP of hospital Revenue Cycle manages the direct oversight and indirect vendor management oversight of patient accounts receivable for all hospitals and hospital revenue cycle related activities within the WellStar Health System. Oversees primary areas, each with a dedicated WellStar Director or Vendor Director which include hospital billing/follow-up, cash management, denials/ payment variance, Revenue Integrity and customer service. Provides leadership and management oversight for revenue cycle areas as directed. Performs complex data analysis and makes independent decisions within the scope of responsibility through a shared vision driven by the Vice President of Revenue Cycle and other senior leadership. Interacts with executives, other directors, and all members of the Revenue Cycle within WellStar Health System, including leaders of health information management, corporate compliance, accounting and medical group revenue cycle. External contacts consist of patients and their families, insurance companies, state and federal agencies, auditors, and vendors. Develops business plans which align and integrate resources for service excellence, employee engagement, and financial growth.

Core Responsibilities and Essential Functions:

Operations and System Integration - Provide operational direction and leadership for areas of the Revenue Cycle assigned, including hospital billing/follow-up cash management, revenue integrity, denials,payment variance, and customer service. - Maintain, update as appropriate, and enforce the adherence to Revenue Cycle and system written policies, procedures, and processes. - Develop and monitor productivity and quality metrics and benchmarks for each area of the Revenue Cycle based on industry standards. Monitor productivity and quality of each area using metrics and provide feedback to management regularly (monthly as a minimum). - Oversee the discharged, not final billed (DNFB)/unbilled accountablity structure for claim and billing edits. - Work closely with the WellStar Connect team to ensure an effective implementation of new billing systems, identify opportunities for system or process improvements with WellStar Connect and beyond, and drive change through targeted initiatives. - Report and review key metrics and progress on outstanding initiatives to the Vice President of Revenue Cycle on a regular basis. - Proficiently use all systems and processes applicable to the job. - Managed vendor contractual relationships, including validation of performance, deliverables and contractual obligations. - Initiate, managed and complete assigned project, project management and systems integration requirements - Identify opportunities for system or process improvements and drive change through targeted initiatives. - Perform other duties and responsibilities as assigned Regulatory and Compliance - Maintain a strong knowledge of insurance billing and reimbursement procedures and federal, state, and local regulations related to insurance billing and collections. - Ensure that all Revenue Cycle activities assigned, are conducted in compliance with all state and federal regulations, and ensure staff are properly educated to accomplish this requirement, through training and written policies and procedures. - Maintains strong knowledge of insurance billing and reimbursement procedures and federal, state, and local regulations related to insurance billing and collections. - Attend and / participate in obtaining information regarding routine updates provided by CMS, payors or others that impact revenue cycle operations, and communicate such information throughout the impacted areas of the company - Initiate communication with peers about changes and procedures. - Relay information appropriately over telephone, email, and other communication devices. Leadership - Facilitate regular staff meetings to communicate departmental and organizational issues, goals, achievements, and changes. - Select, evaluate, counsel, and discipline as required in a positive manner consistent with health system policies. - Maintain a system to informally and formally recognize staff for accomplishments. - Demonstrate excellent customer service through oral and written communication in providing assistance/expertise to patients, families, and other external or internal contacts. - Serve as role model and mentor to co-workers - Oversight of Contractual Modeling and the development of the Contract management build, modeling and transition team. - Oversight of centralized support functions associated with internal and external revenue cycle support functions related to WellStar enterprise support responsibilities. - Delegate work to other staff members as needed. Financial and Budgetary - Responsible for the effective budget development and financial performance of the revenue cycle departments as delegated in the areas of salary expense, supply expense, and capital needs and expenditures. - Perform financial and business cases analysis including but not limited to the calculation of incremental improvement for revenue cycle initiatives, Return on Investment (ROI), department financial Proforma’s related to capital expenditures and new programs. - Responsible for vendor expense management and audit review, reconciliation and invoice processing.

Required Minimum Education:

Master's Degree in Health Care Administration, Nursing, or Business Administration Preferred

Required Minimum License(s) and Certification(s):

Additional Licenses and Certifications:

Required Minimum Experience:

Minimum 10 years hospital and physician accounts receivables experience Preferred and Minimum 7 years progressive leadership including director level responsibility in a complex healthcare organization. Required and Exceptional business acumen including experience in contracting or group purchasing Required and Exceptional interpersonal skills for written, verbal, presentation, and computer communication Required and Experience with leading integration or other large transformation projects Preferred

Required Minimum Skills:

Knowledge of state and federal regulations as they pertain to billing processes and procedures. Knowledge of insurance claim processing and third party reimbursement. Knowledge and detailed understanding of all negotiated agreements. Knowledge of the principles of Information Systems in order to effectively analyze and make decisions. Skill in good oral, written, and interpersonal communication. Skill in problem solving in a variety of settings. Skill in technical or professional accounting. Skill in time management and project management. Ability to work efficiently under pressure. Ability to operate a computer and related applications. Advanced proficiency in Microsoft Excel. Ability to apply appropriate supervisory, management and leadership techniques in an operational setting. Ability to work independently and take initiative. Ability to demonstrate a commitment to continuous learning and to operationalize that learning. Ability to deal effectively with constant changes and be a change agent. Ability to deal effectively with difficult people and/or difficult situations. Ability to willingly accept responsibility and/or delegate responsibility. Ability to set priorities and use good judgment for self and staff. Ability to effectively manage complex vendor relationships. Ability to interpret and ensure compliance of complex vendor contractual agreements