AVP, Hospital Central Billing Office

Exemption Status:

Schedule Details:

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Shift:

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This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities:

1. Develops and oversees strategic and tactical plans in support of the Health Care System's mission and vision, focused on ensuring timely, accurate and compliant claim submission and resolution for all Hospital services provided across UMMHC hospitals.
2. Collaborates frequently with senior leaders of Hospital Finance/Revenue Cycle departments and clinical areas regarding any content or timing issues impacting the ability to produce and/or adjudicate clean claims.
3. Ensures the timely and compliant resolution of any claim holds and edits that delay or prevent submission to responsible third party payers.
4. Oversees the resolution of all Hospital Accounts Receivable on the billing system through subordinate Director(s), Management and staff, ensuring that claims are adjudicated by third party payers correctly and efficiently, in the context of frequently changing and disparate Federal, State and commercial billing guidelines.
5. Oversees, through subordinate Director(s)/Managers and staff, the remediation of any claims denied by third party payers by either correcting the claim data elements causing the denial (if appropriate/compliant to do so) or adjusting the balance on the AR as a write-off or contractual adjustment.
6. Oversees, through subordinate Director(s)/Managers, the development and ongoing maintenance of a sophisticated contract modeling system used to determine the reimbursement expected for each Hospital claim based on clinical services provided to each patient and the relevant insurance payment algorithms, contracts and regulations.
7. Oversees a program of continuous improvement focused on the identification of receivable and denial issues, the determination of root causes, and the development of corrective action plans in collaboration with clinical and revenue cycle leadership.
8. Collaborates with accounting and reimbursement leadership within Fiscal to ensure that the accounts receivable information included on UMMHC financial statements is correct and reliable based on industry standard patient accounting practices.
9. Oversees the development and distribution of meaningful metrics and key performance indicators for UMMHC hospital entities to drive strategic analysis and decision making, and the identification of improvement opportunities.
10. Oversees a large staff through subordinate Directors/Managers, ensuring performance standards are maintained, all regulations and policy guidelines are followed, and a spirit of engagement and front line problem-solving is fostered throughout the Department.
11. Develops and manages operations against associated budgets to determine all spending is within budgetary guidelines.

II. Position Qualifications:

License/Certification/Education:
Required:
1. Bachelor's degree in Business, Health Care Administration or a related field is required.

Experience/Skill:
Required:
1. Minimum ten year's experience working in a revenue cycle management/patient accounting role in a hospital or health system is required
2. Minimum of five years' experience in a supervisory/people management capacity
3. Demonstrated, in depth knowledge of patient accounting and accounts receivable management standards and practices
4. Excellent communication skills including the ability to effectively summarize and convey difficult and detailed topics to senior leadership and build consensus around improvement initiatives.
5. Strong computer skills (e.g., Microsoft Word, Excel, PowerPoint, Project, Visio)

Preferred:
1. Demonstrated knowledge of and experience with clinical and revenue cycle computer systems. Epic clinical documentation/charging/coding experience is preferred.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We're striving to make respect a part of everything we do at UMass Memorial Health - for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.