Revenue Cycle

1.0 FTE, 8 Hour Day Shift

At Stanford Children's Health, we know world-renowned care begins with world-class caring. That's why we combine advanced technologies and breakthrough discoveries with family-centered care. It's why we provide our caregivers with continuing education and state-of-the-art facilities, like the newly remodeled Lucile Packard Children's Hospital Stanford. And it's why we need caring, committed people on our team - like you. Join us on our mission to heal humanity, one child and family at a time.

This paragraph summarizes the general nature, level and purpose of the job.

Under the direction and leadership of the VP of Revenue Cycle, and in conjunction with the Executive Director of Revenue & Billing Integrity, the Revenue Cycle Manager will assist in enhancing and improving revenue yield, year over year. RCM is responsible for promoting financial viability of LPCHS by effectively managing all aspects of the organization's revenue cycle operations. Provides overall direction to identify issues, monitor performance, and assists in problem resolution. Acts as a liaison between vendors and hospital departments to ensure accurate and timely charge capture up to and including missed charge review. Manages staff to meet department's overall achievement of cash target, account receivable goals, and quality and productivity measures. Consistently monitors appropriate patient admitting, registration, billing, and collections by payor requirements to ensure maximum reimbursement.

This position is a hybrid role that requires 20-40% onsite. Healthcare experience with hospital billing, denials management, AR management, and supervisor experience is preferred. Epic experience highly preferred. Strong analytic and project management background is a plus.

Essential Functions:

• Assists with the implementation of regulatory and quality standards as they relate to or impact the overall functioning of revenue cycle programs.
• Conducts regular staff meetings to disseminate and discuss information concerning unit workflow, processes, challenges, successes, goals and solutions.
• Determines resources required for effective administration and operation of admitting and registration; develops budgets and maintains expenses within target limits; monitors budgets and resolves variances.
• Determines the number and qualifications of staff needed for revenue cycle operations, and provides supervision and leadership to staff.
• Develops and implements policies and procedures related to all aspects of the revenue cycle process including: registration, authorization/insurance verification, charge capture, coding, reconciliation, payor contract performance, and training.
• Develops and implements systems and business controls to monitor staff compliance; ensures staff are operating under all applicable standards.
• Directs and supervises the daily activities and workflows of registration and financial counseling staff to ensure that work areas are staffed appropriately, breaks are taken and overtime is utilized appropriately.
• Ensures compliance with federal and state laws, specifically pertaining to revenue cycle by analyzing internal policies, and implementing appropriate charges.
• Ensures reimbursement processes and procedures are set up and in compliance with established LPCHS policies and procedures and follow all state and federal guidelines for insurance payors; and works with Financial Clearance Department to resolve problems associated with authorization or billing functions.
• Ensures that all staff follow appropriate registration requirements and receives necessary compliance training.
• Ensures timely updates to the registration system (Epic) for appropriate registration edits.
• Establishes and maintains administrative policies, procedures, processes, and standards for all registration, billing, and collections; ensures business policies and procedures are congruent with established Patient Accounting practices and standards.
• Communicates issues and risks to the Executive Director.
• Establishes appropriate and industry standard financial benchmarks for staff, and develops utilization and productivity standards; develops systems to improve and provide in depth financial analysis of operations; and provides financial spreadsheets and reports determining the feasibility of a new initiatives.
• Manages the day-to-day business and administrative functions relating to the operation of registration, billing, and collections.
• Monitors the financial success of insurance and Self-Pay billings and collections by ensuring registration and admitting guidelines are appropriately documented and performed; and ensures that established policies and procedures are followed to ensure maximization of revenues for new programs and services.
• Participates in development, implementation and maintenance of policies, objectives, short-and long-range planning; develops and implements projects and programs to assist in accomplishment of established goals.
• Performs supervisors functions by interviewing, selecting and providing training for new staff; by approving or disapproving recommendations from subordinate staff on personnel actions; by evaluating subordinates' performance; by hearing and resolving employee grievances; and by determining the need for and initiating disciplinary action in order to ensure adequate and competent staffing for the department, division or institution.
• Provides overall direction and supervision to the registration, admitting, and correct billing of all payor accounts.
• Serves as a contact to other departments for information on admitting and registration guidelines; updates staff and outside departments on Medi-Cal/Medicare and commercial regulations.
• Teaches staff how their functions impact bad debt expense-uncompensated care, cash flow, and accounts receivable as well as customer loyalty, market share and the overall financial health of Stanford Hospital and Clinics.
• Works with staff to ensure appropriate registration, admissions, information gathering, account activation, collection of co-pays and deductibles are performed in an efficient and courteous manner.

Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

Education: Bachelor's degree in a work-related discipline/field from an accredited college or University.

Experience: Five (5) years of progressively responsible and directly related work experience.

These are the observable and measurable attributes and skills required to perform successfully the essential functions of the job and are generally demonstrated through qualifying experience, education, or licensure/certification.

• Ability to adjust communications to fit the needs and level of understanding of the receiver.

• Ability to develop long-range business plans and strategies.

• Ability to establish and maintain excellent client relationship, exhibit exemplary interpersonal skills and exercise sound judgment and professionalism in business and personnel matters.

• Ability to foster effective working relationships and build consensus.

• Ability to mediate and resolve complex problems and issues.

• Ability to provide leadership and influence others.

• Ability to recognize and analyze the impact of regulatory changes on the financial performance of commercial revenue.

• Ability to solve problems and identify solutions.

• Ability to speak, read, write, and understand English effectively at a level appropriate for the safe and effective performance of the job.

• Knowledge of accounts receivables and reimbursement management.

• Knowledge of CPT, ICD9 coding and medical terminology.

• Knowledge of government program regulations and requirements as they relate to billing and collections of accounts receivable.

• Knowledge of information system and software relating to accounts receivables management and billing.

• Knowledge of managed care environment and patient service delivery systems and knowledge of federal and state rules and regulations regarding billing processes.

• Knowledge of principles and practices of organization, administration, fiscal and personnel management.

• Knowledge of project management process and systems.

Physical Requirements and Working Conditions

The Physical Requirements and Working Conditions in which the job is typically performed are available from the Occupational Health Department. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions of the job.

Pay Range

Compensation is based on the level and requirements of the role.

Salary within our ranges may also be determined by your education, experience, knowledge, skills, location, and abilities, as required by the role, as well as internal equity and alignment with market data.

Typically, new team members join at the minimum to mid salary range.

Minimum to Midpoint Range (1.0 FTE): $115,585.60 to $153,254.40

Equal Opportunity Employer