Director of Patient Business Services - Revenue Integrity

Santa Clara County; San Jose (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

The Santa Clara County is seeking a Director of Patient Business Services to oversee billing operations and ensure compliance within the Santa Clara Valley Health and Hospital System. This leadership role involves guiding staff, managing revenue cycle activities, and implementing policies to meet organizational goals.

Qualifications

• Five years of professional-level experience in managing a healthcare-related patient accounting office.
• Must obtain Epic certification within six months of appointment.

Responsibilities

• Directs functions of Patient Business Services, ensuring compliance and revenue cycle success.
• Supervises staff hiring, training, and performance evaluation.
• Implements policies and ensures operational quality improvements.

Skills

Operations Management

Patient Billing

Compliance Knowledge

Training and Development

Project Management

Customer Service

Problem Solving

Decision Making

Communication

Education

Bachelor's Degree in Health Care Administration

Job description

Under general direction, to plan, direct and coordinate the functions and staff of Patient Business Services (PBS) within the Santa Clara Valley Health and Hospital System (SCVHHS) and to assist in developing patient billing and revenue collection policies.

The current vacancy in Revenue Integrity Unit is responsible for ensuring the timeliness, accuracy, completeness and compliance related to charge capture. The Director for this unit will support clinical departments in the clinical capture and triggering of charges for patient services provided; and the resolution of any charging pending due to provider delays or errors (e.g., charges landing in Charge Router or Charge Review work queues). In addition, the Director will ensure all services provided at 4 Acute hospitals, Sub Acute unit and health care centers for outpatient and inpatient services are built and maintained within the HealthLink Charge Description Master for both Hospital and Professional services. This includes ensuring charges exist and are active (or inactive) with the HCPCS/CPT codes, Revenue Code, and Pricing. The Director will partner with Billing teams to assure CDM output aligns with payor billing requirements as well as organizational pricing strategies, which will also assist in achieving maximum reimbursement for the health system. Assuring compliance with regulatory standards and organizational goals.

The eligible list may be used for other positions within PBS Department.

• Guides and directs subordinate staff on the functions of Patient Business Services;
  
• Selects, hires, evaluates and ensures the orientation, training and development of staff;
  
• Directs and monitors the day to day functions of all areas of Patient Business Services; ensures and maintains effective patient billing revenue collections;
  
• Provides key leadership in ensuring Valley Medical Center's success in meeting its Mission and Values commitment;
  
• Plans, organizes, directs, and evaluates subordinate management staff;
  
• Develops, implements and monitors operational policies and procedures;
  
• Directs operational Continuous Quality Improvement Program within Patient Business Services;
  
• Directs Patient Business Services Compliance Program;
  
• Identifies, analyzes, interprets and monitors regulatory requirements and trends which may have financial or operational impact; recommends, develops, directs and/or implements necessary actions;
  
• Collaborates with technical staff to assess, design, create, modify and troubleshoot information systems to develop, support, enhance and maintain the operations, processes and performance of patient accounting and associated operations;
  
• Directs and monitors compliance with all applicable regulatory requirements;
  
• Prepares annual department goals and objectives in collaboration with subordinates;
  
• Develops and provides reports regarding account receivables and Patient Business Services performance;
  
• Prepares, oversees and monitors the patient business services budget and performance;
  
• Assists patients, physicians and department personnel in resolving billing and/or collections problems;
  
• Represents the department in internal and external meetings on matters involving Patient Business Services;
  
• Acts in the absence of the Revenue Cycle Director;
  
• May be assigned as a Disaster Service Worker, as required;
  
• Performs other related duties as required.

Sufficient education, training and experience to demonstrate possession of the following knowledge and abilities:Training and Experience Note:The knowledge and abilities required to perform this function are acquired through training and experience equivalent to a Bachelor's Degree in Health Care Administration, Accounting, Business Administration, or a related field and five (5) years professional level experience in managing a health care related patient accounting office.Certification: Must obtain appropriate Epic certification within six (6) months of appointment or vacate the position.Knowledge of:

• Operations of a patient business services for a large complex health care facility; including clinic, hospital, ancillary and professional fee billing and collection;
  
• Special County or Federal Programs;
  
• Patient accounting information systems;
  
• Cash processing and general accounting practices;
  
• Diagnostic and procedure coding;
  
• Charge Entry;
  
• Principles and practices of organization, administration and personnel management, including selection, supervision, discipline, training and staff development;
  
• Healthcare laws and regulations and requirements for third party billing (Medicare and Medi-Cal);
  
• Principles and practices of budgetary preparation and control;
  
• Office management principles, methods and procedures;
  
• Principles of patient relations and customer service;
  
• Human resource principles and practices, including labor organizations, labor laws, etc.;
  
• Principles and practices of change management;
  
• Project management;
  
• Principles and practices of continuous quality improvement;
  
• Compliance issues as they relate to the billing and collections of facility and professional fees.

Ability to:

• Manage, train, develop and motivate subordinate staff;
  
• Direct, administer, coordinate and supervise the patient business services functions of a large health and hospital system, including but not limited to the billing and collections of facility and professional services;
  
• Identify problems which negatively impact the efficient operations of Patient Business Services and develop and implement procedural changes and/or recommendations;
  
• Understand, apply and implement applicable hospital policies, regulations and administrative procedures;
  
• Direct, coordinate and/or motivate the activities of groups, including groups that may not have a direct reporting relationship;
  
• Quickly and accurately access and resolve complex issues;
  
• Give presentations to large groups;
  
• Keep informed of, analyze, interpret, and implement State and Federal regulations;
  
• Manage difficult and sensitive policy issues; and management problems;
  
• Be self directed and make sound independent decisions;
  
• Work cooperatively and effectively as a member of a management team;
  
• Establish and maintain cooperative working relationships;
  
• Communicate effectively both verbally and in writing;
  
• Write clear and concise correspondence and reports.