PFS DIRECTOR- FULL TIME

Summary/Objective:

Position is responsible for all aspect of Patient Financial Services.  Areas of responsibility includes Revenue Cycle Management, Emergency Department patient registration, OutPatient registration, and billing office activities.  Supervisory responsibilities for team leaders.

Essential Functions:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Revenue Cycle Management
   1. Oversees and manages all aspects of the patient revenue cycle.  Includes activities such as, but not limited to, insurance benefits/eligibility verification, OP procedure/surgery authorizations, scheduling, registration, accurate charge posting, billing, follow-ups, denials, credit balance, bad debt collections, etc.
   2. Addresses patient complaints when escalated beyond front-line team members and respective supervisor.  Counsels team members on appropriate response and action to be taken depending upon specific circumstances
   3. Develops and implements specific performance improvement practices and goals to secure desired results, monitor team member performance, and achieve optimal performance
   4. Assists the supervisor in recruitment, development & motivation of the team(s) for the purpose of retaining high-caliber/high-performing team(s)
   5. Maintains an excellent working knowledge of payer and regulatory billing and collection policies/guidelines.  Communicates information to team members and ensures compliance.
   6. Communicates insurance updates to team members and ensures awareness of impact to registration &/or billing practices.
   7. Communicates in a timely manner to CFO, Compliance Officer, and CEO in the event of non-routine patient account concerns &/or potential legal action.
2. Insurances/Managed Care Contracts & Credentialing
   1. Advises Managed Care/Credentialing Specialist when discrepancies are discovered regarding either payer contracts &/or specific provider credentialing.
   2. Disseminates, in a timely manner, to appropriate teams, all 3^rd-party provider process &/or authorization changes provided to the Hospital District
3. Reporting & Trending
   1. Position is responsible for all reports related to all Patient Revenue Cycle activity.  This includes, but is not limited to, monthly reports related to AR activity, small balance, and collection activity.
   2. At the direction of the CFO, creates reports as needed to meet reporting requirements by CMS &/or other outside agencies.
   3. Maintains knowledge of key performance indicators for improving team performance against national, state, acute, & CAH metrics
   4. Analyzes, evaluates, and reports data to optimize the use of resources, identify opportunities, and focus team member’s actions.
4. Supervision & Department Leadership
   1. Maintains departmental policy & procedures.  This includes establishing, reviewing, and revising P&P at least annually, more frequently, if a need is identified.
   2. Ensures timely dissemination of Sweeny Hospital District, Sweeny Community Hospital, Human Resources, & Safety policy & procedures
   3. In partnership with the CFO and Human Resources, position manages all aspects of the department’s Human Resources activities. Duties include, but may not be limited to recruiting, hiring, disciplinary actions, training, mentoring, counseling, performance evaluations & salary planning
   4. Prepares Patient Financial Services and Sweeny Care Program budgets in response to CFO’s direction
5. Financial Controls
   1. Maintains control documentation for denial management and insurance/patient refund check distribution
   2. Serves as department’s primary technical resource & coordinates activities with Information Resources Technology
   3. Coordinates and fosters relationship with internal and external business partners regarding issues impacting AR management and best practices
   4. Assures daily financial reports are completed timely
   5. Assures that appropriate segregation of duties are maintained related to cash handling of petty cash and the OP Services cash box

Competencies:

1. Communication
   1. Answers phone calls, e-mail, and face-to-face communication in a prompt, profession and courteous manner.
   2. If delays/road-blocks are encountered, timely communication to all parties involved is expected.
   3. Keeps CFO informed of progress or delays related to assigned duties or special projects
2. Ethical Conduct – Individual must exhibit & model ethical conduct in all aspects of the position.  Individual must have a previous work history free of any unethical performance concerns.
3. Confidential Conduct – Individual must exhibit absolute confidential conduct in execution of daily duties.  At no time will any breech of maintaining confidentiality be tolerated.
4. Flexibility – Individual must exhibit flexibility and willingness to be trained for the completion of special projects  or direct the completion of special projects as assigned by the CFO.  Routinely meets &/or beats expressed deadline.  Monitors work unit coverage and flexes as necessary to maintain work unit performance.

Supervisory Responsibility:

This position has supervisory responsibilities for billing supervisor, ED registration supervisor, OP registration supervisor, and Sweeny Care Program coordinator.

Work Environment:

This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, fax machines, and other equipment as needed.

Physical Demands:

The physical demands described as follows are representative of those that must be met by an employee to successfully perform the essential functions of this job.   This position requires the ability to sit for long periods of time. 

While performing the duties of this job, the employee is regularly required to talk and hear.  Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Must be able to lift, push, or pull up to 10 lbs.

Position Type/Expected Hours of Work

This is a full-time position, and core hours of work are Monday through Friday.  Weekends and holidays off.  May be required to attend occasional meetings after hours.

TRAVEL

Occasional travel is required for this position.

Required Education, Experience and License

High School diploma or equivalent – courses in healthcare administration or business desired

5 years experience in healthcare billing/administration with supervisory experience

Preferred Education, Experience and License

BA/BS in Healthcare Management or Business Management is preferred

Additional Eligibility Qualifications

Work Authorization/Security Clearance (if applicable)

AAP/EEO Statement

Sweeny Community Hospital provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.