Manager, Quality & Training

Job Details
Job Summary:
The primary role of this position is to develop and execute a strategic plan to operate "best in class" Revenue Cycle Quality and Training for all EMHS members. The Quality and Training Manager within the System Revenue Cycle Department of EMHS needs to be able to oversee education and quality compliance analysts with the primary role of improving EMHS Revenue Cycle processes system wide without reducing quality or service. This position will assist in managing end to end planning, training, communication, and adoption of change throughout EMHS revenue cycle in conjunction with other System Revenue Cycle leaders and the Chief Revenue Officer. This position will identify, analyze, and track risks to revenue preservation, develop and maintain quality assurance monitoring, while providing constructive feedback and remediation training system wide. This position will provide "shoulder to shoulder" education and coaching to its customers while ensuring compliance with revenue cycle processes and protocols supported by EMHS Revenue Cycle Directors. This position is also responsible for collecting, consolidating, and maintaining system Revenue Cycle policies and other process documents to deliver education and end user training. This role will collaborate with customers to help achieve goals supporting efficiency, increased revenue, and minimized costs. This position will incorporate the organization's mission, vision and values into all staff development practices and all departmentally directed activities.
It is critical this position be highly effective in delivering the services described in the Job Functions and Duties below and work harmoniously with staff across EMHS. Effectiveness will be measured in terms of results, commitment to EMHS and customer satisfaction (at all levels).
This position is a member of the EMHS Revenue Cycle team. Duties may be changed or reassigned by the Chief Revenue Officer as need arises.
Job Functions and Duties:
1. Provide strategic direction and oversee the operation and process design of procedures to ensure efficient functioning of Quality and Training team.
2. Ensure development of industry best practice operating procedures with consistent application in all business units.
3. Maintain compliance standards for providing accurate information on all hospital and provider activities.
4. Serves as a resource on Quality and Training, data gathering, measurements, KPI development, and outcome measurements to all areas of Revenue Cycle.
5. Achieve annual and periodic goals and key performance indicators in support of Quality and Training operations and overall financial performance.
6. Manage, prepare and present budgets that demonstrate prudent use of the organization's resources. Achieve planned results for Quality and Training operations.
7. Monitor and support daily staff functions in all areas related to the scope of the department's responsibility.
8. Direct ongoing programs for staff development and training that foster and mentor the next generation of Quality and Training leaders.
9. Ensure strong technology functionality to support all elements of Quality and Training as it relates to revenue cycle and interfaces with clinical and other operational areas.
10. Ensure effective communication and coordination with other functional areas to achieve desired service levels.
11. Work closely with Revenue Cycle staff to ensure best practices and hospital wide regulatory compliance.
12. Provide training utilizing reimbursement and compliance materials to reduce revenue leakage.
13. Coordinate a collaborative process for the development of policies and procedures.
14. Work collaboratively with department heads to identify best practices and help develop performance standards that can be tracked and reported.
15. At the direction of the Chief Revenue Officer, provide formal reports and presentations to management teams, physician groups and EMHS affiliated members.
16. Assist with special analysis and projects as needed.
17. Seek and recommend new information technology solutions and or manual changes that support Quality and Training departmental functions.
18. Work collaboratively with departmental personnel to implement tools and process changes aimed at improving revenue cycle performance.
Management Reporting and Monitoring
19. Review and analyze on-going revenue cycle performance based on computer generated data and manual reports (ATB'S, Days in A/R, Bad Debt Turnover, Contractual allowances, claims denials, late charge activity, accounts discharged/not final billed, Charity Care write offs and other deductions to Revenue).
Training & Education
Educate departments and operational areas regarding the impact of their department on the revenue cycle in the areas of Access, HIM, PAS and Revenue Integrity.
Work closely with operational directors and managers to identify common areas of deficiencies and create training sessions to correct the noted deficiencies.
Professional Development
Attend local and regional conferences/seminars to remain current in supporting the needs of revenue cycle activities.
Reviews Third Party Regulatory publications to maintain knowledge base concerning compliance, billing requirements, reimbursement and coverage issues. Will distribute notifications of all changes in billing requirement/coverage issues as appropriate.
Maintains current knowledge of regulatory developments involving agencies such as CMS, MHDO, DHS, and Joint Commission.
Perform other duties as assigned.
Note: the duties listed above reflect the majority of the duties of this job and does not, nor is it intended to, reflect all duties that may be required for an incumbent in this job to perform.
Education and Experience:
Bachelor's degree OR associate's degree and four (4) years of progressive, relevant knowledge toward mastery in the field OR high school diploma/GED and eight (8) years of progressive, relevant knowledge toward mastery in the field required. Master's degree in hospital administration, or business preferred.
Six years' experience in monitoring, assessing, and evaluating quality assurance in a revenue cycle setting required.
Demonstrated skills in financial and statistical analysis necessary to examine revenue cycle activities and detect/resolve any related issues.
Expertise with regulations and accreditation standards, knowledge of specific state and federal requirements and standards as it relates to modern revenue cycle systems.
Must be able to problem solve in a high profile and high stress area and interact positively with all internal and external customers while possessing the ability to determine priority of work and flexibility.
Demonstrated experience in establishing and maintaining long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
Demonstrated experience in overseeing the development, deployment and direction of complex programs and processes.
Licenses and Certifications:
Certified Revenue Professional certificate within one year of employment.
Certified Compliance certificate within three years of employment.
Knowledge, Skills, and Abilities:
Ability to guide individuals and groups toward desired outcomes, setting high performance standards and delivering quality service.
Detailed knowledge of revenue cycle, reimbursement, and auditing principles.
Working knowledge of medical terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10), and HIPAA ANSI codes.
Working knowledge of Microsoft Office, Excel, Access, Siemen's, Monarch, Allscripts, Meditech, and other revenue cycle systems.
Ability to proactively make appropriate changes in business analytics to position EMHS for healthcare reform and competition.
Ability to effect collaborative alliances and promote teamwork.
Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.
Effective organizational, planning, controlling, scheduling and project management abilities.
Effective leadership abilities.
Ability to effectively influence change.
Excellent communications skills, both oral and written.
Ability to proactively prioritize needs and effectively manage resources.
Flexible and able to react to ever changing priorities.
Travel Requirements:
15 ? 50% travel may be required.
Employee must have a valid drivers' license and possess own transportation.

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