Provide coordination, support and oversight to all aspects of the revenue cycle throughout the organization and enhance and maintain a properly functioning revenue cycle process through a cross-department organizational structure. The position includes intake, service charge capture, billing, accounts receivable, follow-up and collections. Proactive and responsive leader, overseeing the systems and managers, plus other related processes. Responsible for ensuring the accuracy and completeness of reporting. Concentrates resources on improving core clinical care delivery systems and protecting the assets of the organization. Critical responsibility includes achieving annual and periodic goals for significant statistical indicators of revenue cycle performance and for the organization’s overall financial performance. Responsibility for the overall strategy of the multiple departments they are responsible for including future state planning, systems, staff, training, designing and implementing such strategy.
Essential Duties and Responsibilities
Responsible for solution planning including defining scope and planning for new solutions. This includes determining how to measure business results, modeling current/future business processes, gathering business requirements and identifying the organizational changes required to successfully realize the benefits of the solution.
Drives collaborative decision making process by performing detailed cost/benefit analysis, presenting and evaluating solution options and driving consensus among key stakeholders.
Insure that Revenue Cycle processes are compliant with governmental and regulatory requirements (in conjunction with support and advisory consultation from Corporate Compliance), reimbursement and internal audit issues in a timely manner.
Monitor and report daily/weekly/monthly performance metrics and intervene when necessary and interprets all billing, collections and financial reports.
Assure timely and accurate data reporting regarding revenue cycle activity.
Interface with IT, HIM, Operations and Practice Managers and Finance for Revenue Cycle processes and systems.
Research trends and best practice for developing strategies to optimize appropriate revenue generation. Stay current in identifying trends affecting the revenue cycle.
Design the necessary training programs and assure consistent performance.
CPA, CPAM or FHFMA certifications are preferred.
Proven work record that demonstrates, in depth knowledge of hospital and physician billing and reimbursement.
Skills in using mainframe and PC computers, IT system selection and experience.
Knowledge of medical terminology
Knowledgeable in current healthcare trends/policies and managed care (Florida preferred).
Extensive knowledge of HCPCS, ICD, CPT's, Revenue Codes, DRG, payment methodologies, managed care operations.
Ability to compile data, analyze, report data and make decisions that support department and company objectives.
Ability to work with various financial and clinical departments collaboratively.
Demonstrated ability to develop strong and collaborative relationships.
Excellent communication, organization and interpersonal skills as well as aptitude for conflict resolution, problem-solving and staff development.
Know and understand hospital financials, reports and tools.
Possess analytical and problem solving skills.
Problem solving skills to approach new regulations/situations with an imaginative, innovative and analytical skill.
Knowledge Lean/Six Sigma highly preferred
Internal Number: 13581
About Nicklaus Children's Health System
At Nicklaus Children’s Hospital, we are driven. Everything we do revolves around one central purpose, to provide the best pediatric care. To achieve this, we strive to be the best in medicine, the best in research and technology and the best hospital of the community. Being the best requires passion, direction and purpose. Because at Nicklaus Children’s Hospital, impacting the lives of children and their families is as much a part of who we are as it is what we stand for. We are Purpose. We are Nicklaus Children's Hospital; Miami Children's Health System.