Director for Patient Financial Services

Stanford Health Care

(Palo Alto, California)
Full Time
Job Posting Details
About Stanford Health Care
At Stanford Health Care, we seek to provide patients with the very best in diagnosis and treatment, with outstanding quality, compassion and coordination. With an unmatched track record of scientific discovery, technological innovation and translational medicine, Stanford Medicine physicians are pioneering leading edge therapies today that will change the way health care is delivered tomorrow.
Summary
This position directs the Patient Financial Services (PFS) department which has the responsibility for all patient related business activities including insurance billing, governmental program billing, commercial/managed care billing, special billing (transplants, grants, IMS, sports medicine) and payment application. Assures compliance of regulatory requirements, facilitates communication and provides effective leadership. Will have responsibility for ensuring the provision of best practice, customer-focused and cost-effective patient financial services for the organization.
Responsibilities
* Monitors and evaluates current reimbursement/payment rules and ensures that legislative and regulatory changes impacting PFS billing practices and operations are anticipated and communicated to senior management, clinical department chairs, staff, and departmental billing personnel. Develops plans and initiate response to legislative changes. * Oversees resolution of third party denials and assists with reimbursement appeals and problems. * Directs operation of revenue collection; develops policies and procedures that ensure appropriate effectiveness of collection of accounts receivable * Monitors and maintains all outsource vendor and collection agency relationships to ensure they are in compliance with system policy, and state and federal regulations including quality and maximum return on investment. Provide targets and goals to measure effectiveness and report on the attainment of the goals * Directs operation of third party billing and responsible for development of policies and procedures that ensure the appropriate maintenance of PFS commercial, governmental, managed care, and special billing and accounts receivable systems. * Develops departmental strategies to meet cash projection formulas, reduce days in Accounts Receivable, and reduce denials * Directs operations of cash posting and oversees the coordination and activities of cash posting with those of other departments within PFS and the Hospital. Oversees the activities related to the maintenance of the EPIC Account Receivables System and responsible for reconciliation of EPIC system to General Ledger (GL). * Ensures that accounts receivables system report and Critical Reduction Schedule (CRS) tools are used as daily management tools for successful ongoing and proactive management of A/R. Challenges Managers to question trends, unusual numbers, and source documents to ensure they understand what the numbers represent, and what actions are required to resolve issues identified. * Manages the department to ensure achievement of functional and budget/financial goals. Selects, develops, motivates and evaluates the performance of assigned supervisors and/or individual contributors. * Oversees Accounts Receivables system administration reporting and distribution. Monitors delinquent aging percentages, bad debt write-offs and ensures progress toward goals; evaluates revenue trends and the impact on the accounts receivable (A/R) days calculation. * Oversees coordination of defense audit with insurance companies; reviews over charges and undercharges on a monthly basis and directs upstream process changes; oversees the reporting of charity and governmental patient health care subsidy funding. * Represent Patient Financial Services' contributions, issues, and solutions to organization-wide groups and committees such as A/R Task Force, In-house High Dollar Account Review, etc. to ensure appropriate communication and problem solving across the Revenue Cycle. * Reviews and evaluates on a regular basis, the effectiveness of third-party billing, tracing and follow-up activities; oversees development and maintenance of good working relationship with third parties and government agencies receiving claims from PFS * Maintains knowledge for all insurance, government, HIPAA, compliance, health care reimbursement, OIG projects, and general billing practices and state regulations/laws to ensure Patient Financial Services is following the appropriate guidelines/regulation and remains in compliance with the same. Act as the Patient Financial Services liaison with State and Federal fiscal intermediaries as needed or requested. * Leads and directs continuous process improvement projects.
Ideal Candidate
**Education:** Bachelor's degree in a work-related field/discipline from an accredited college or university **Experience:** Ten (10) years of progressively responsible and directly related to the management of hospital Patient Financial Services is required. LEAN and/or Six Sigma experience strongly preferred. **License/Certification:** None **Knowledge, Skills, and Abilities** * Ability to analyze complex changes in third party payor requirements for impact on operations and make related recommendations * Ability to develop long-range business plans and strategy * Ability to foster effective working relationships and build consensus * Ability to identify and correct data collection, billing, and/or collection procedural or systems deficiencies * Ability to mediate and resolve complex problems and issues * Ability to provide leadership and influence others * Ability to stay abreast of all Governmental and industry trends in the functional area * Demonstrated interpersonal skills; success at cultivating strong relationships with internal and external stakeholders and creating partnerships at all levels within the organization. * Manages up and self extremely well * Demonstrated and effective written and oral communication skills * Ability to effectively manage complex issues simultaneously. * Ability to effectively present complex issues to internal and external customers. * Strong familiarity with information and accounting systems. * Ability to assess and evaluate complex financial data * Demonstrated workflow and analytical thinking skills * Demonstrated communication skills and ability to effectively communicate with all levels, including senior executive levels * Knowledge of accounting/finance principles that directly impact the account receivables, charge transfers, contractual allowances and adjustments, financial class changes and revenue reclassification, and reserve methodology and mechanics * Knowledge of third-party billing and collection processes, with particular focus on billing requirements, contractual arrangements, utilization guidelines, and certification/authorization processes, for both institutional and professional fees * Demonstrated analytical ability and organizational skills necessary to assess, prioritize, and organize information/tasks, and provide timely recommendations based on analytical assessment * Highly confident, results-driven person. Focused on achieving the goals of the organization * Knowledge of CPT, ICD-9 coding * Knowledge of automated billing systems * Knowledge of local, state and federal regulatory requirement related to the functional area * Knowledge of principles and practices of organization, administration, fiscal and personnel management * Knowledge of private insurance and other third party billing, follow-up and collection requirements

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