I. JOB SUMMARY/RESPONSIBILITIES:
- Oversees, manages and evaluates clinical and financial processes to improve revenue results, ensures integrity, and safeguards The Queen’s Health Systems (QHS) medical facilities against exposure and penalties.
- Provides leadership and oversight in the accomplishment of organizational goals and objectives related to revenue integrity, managed care contracts, government reimbursement activities, and QHS Charge Description Masters (CDM).
- Prepares and presents financial reports for executive management review.
- Manages and directs the development and implementation of new and existing managed care contracts.
- Provides oversight over existing managed care contracts to ensure compliance and optimal financial and operational performance.
- Develops, manages and sustains relationships with third party payers and other external contacts.
II. TYPICAL PHYSICAL DEMANDS:
- Essential: finger dexterity, seeing, hearing, speaking.
- Continuous: sitting, static gripping of an object for prolonged periods.
- Frequent: walking.
- Occasional: standing, stooping/bending, climbing stairs, walking on uneven ground, lifting and carrying usual weight of 1 pound up to 5 pounds, reaching above, at and below shoulder level, frequent gripping of an object.
- Operates computer, calculator, telephone, fax and printer.
III. TYPICAL WORKING CONDITIONS:
- Not substantially subjected to adverse environmental conditions.
IV. MINIMUM QUALIFICATIONS:
A. EDUCATION/CERTIFICATION AND LICENSURE:
- Bachelor’s degree in Business Administration, Finance or Health Care Administration.
- Master’s degree preferred.
B. EXPERIENCE:
- Three (3) years supervisory/leadership experience.
- Five (5) years experience in revenue cycle, including revenue integrity, charge capture, compliance, pricing and reimbursement, preferably in a comparable hospital.
- Prior experience in healthcare insurance provider contract negotiations experience preferred.
- Experience to demonstrate:
o Knowledge of contracts, financial analysis methods, accounting principles and health care delivery systems.
o Knowledge of requirements specific to government-funded health care program and third party payer reimbursement.
