Education:  Bachelor's Degree preferred or 10 years of revenue cycle experience in a healthcare setting

Licenses/Certifications: Membership and/or participation with a Revenue Cycle Association (i.e., HFMA, AHIMA, NAHAM, etc.) preferred.

Experience / Knowledge / Skills:

• Bachelor’s degree requires five (5) to seven (7) years of hospital/healthcare business office or financial management experience with a minimum of three (3) years of formal or informal leadership experience. No degree requires a minimum of ten (10) years of hospital/healthcare business office or financial management experience with a minimum of three (3) years of formal or informal leadership experience.

• Experience in one of the revenue cycle functions, including but not limited to: Patient Access Management, Denial Management, Insurance Collections, Patient Remittance Posting, Claim Submission, Contract Management, or Appeals.

• Experience and working knowledge of health system administrative and clinical applications.

• Experience leading teams and managing multiple entry-level and experienced employees.

• Knowledge of payer contract agreements, billing practices, rules, and regulations for Medicare, Medicaid, Veterans Administration, and other state funded plans such as HHSC, Crime Victims, DARS, etc.) and all relevant state and federal laws regarding medical billing, including HIPAA privacy and security regulations.

• Knowledge of Medicare DDE, CWF, and TMHP on line system functionality.

• Knowledge of National Correct Coding Initiatives (NCCI), Medically Unlikely Edits (MUE), Medicare Secondary Payer (MSP), National Clinical Trial/Research, and other government applied claim edits and billing practice rules.

• Understanding of process management, system implementations and system maintenance.

• Strong interpersonal, customer-oriented skills. Must have proven organizational skills with an ability to effectively prioritize present information publicly, and communicate in writing clearly, concisely, thoroughly, and accurately.

• Must have experience in working with computer software, and be able to demonstrate strong analytical and problem solving skills, decision making skills, stress management skills and time management skills.

Principle Accountabilities:

• Responsible for oversight and management of government payer billing for multiple acute, post-acute, and outpatient locations including 17 acute care facilities and 163 ambulatory locations.

• Service lines include, inpatient and outpatient, emergency services, life flight, trauma, transplant, outpatient imaging, laboratory, inpatient/outpatient rehab, skilled nursing, and chemical dependency.

• Management of approximately two billion claims per year.  

• Direct supervision of a team of 15-20 staff members, including all human resource related activities such as hiring and performance management. Ability to create performance measures, goals, and produce sustainable outcomes.

• Evaluates the performance level of the unit and individuals. Defines performance expectations, measurement tools and policy and processes. Assist in the development of training programs/initiatives to enhance skills, knowledge and productivity of existing employees.

• Develops, implements and improves billing strategies and work plans that optimize billing performance and minimize billing expense.

• Serves as a liaison with facilities to identify reasons for billing issues, identifies and creates a positive plan of action to resolve accounts and mitigate avoidable claim edits.

• Uses analytical approach to problem solving using quantified data and measurable results to reach sound conclusions.

• Works collaboratively with all departments to ensure operational functions are aligned with strategic goals. Identify key stake holders of the organization.

• Builds trust and partnership amongst the team by enhancing engagement, addressing performance results and providing coaching and mentoring.

• Attends meetings with both contracted, non-contracted payers, and TMHP representatives to identify and resolve billing issues/discrepancies resulting in claim rejections or denials.

• Maintains current knowledge of CMS and TMHP billing requirements and establishes plans of action to address process or technology updates needed to ensure compliance with billing practices.

• Manage effective business unit meeting with clear objectives that align to business unit, department, and overall revenue cycle operational and financial goals.

• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.

• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.

• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.

• Other duties as assigned.