Career and Job Postings

6-13-2018 - Chief Financial Officer

Lindner Center of HOPE, is a nationally recognized leader in behavioral health care, located in Mason Ohio.  We have an excellent career opportunity for an experienced leader to be a member of the Team leading this evolving organization as the next Chief Financial Officer.

The CFO is responsible for all financial and fiscal management for the Lindner Center of HOPE and Lindner Center of HOPE Professional Associates (LCOHPA).  This position provides leadership and coordination in the administrative, business planning, accounting, budgeting, and revenue cycle efforts, including preparation of financial reports, summaries and forecasts for future growth.

Major Duties and Responsibilities:

  1. Oversee accounting, budget preparation, and audit functions. Directs the preparation of all financial reports, including income statements, balance sheets, statistical and productivity reports, reports to the Finance Committee & Board, tax returns and reports for government regulatory agencies (e.g. Medicare and Medicaid cost reports). 
  2. Work with Revenue Cycle Director to develop, implement, and manage efficient operational policies, processes and best practices, in relation to insurance verification, financial counseling, medical records, hospital and physician billing and collections, payer contracting, and charge master maintenance. 
  3. Establish and maintain appropriate internal control safeguards.  Ensure compliance with local, state, and federal financial reporting and other financial requirements. 
  4. Analyze cash flow, revenue, and expenses to guide business decision making. Analyze financial statements to pinpoint potential weak performance areas. 
  5. Work with Development Director to appropriately manage and utilize donated funds. 
  6. Create, coordinate, and evaluate the financial programs and supporting information systems. Approve and coordinate changes and improvements in automated financial and management information systems.

Position Qualifications:

  1. Degree in business administration, accounting or finance.
  2. C.P.A. preferred. 
  3. Knowledge of database and accounting computer application systems to supply the most accurate financial information.  Knowledge of patient financial systems and processes.
  4. At least five years of experience as a chief financial officer in a healthcare organization with a proven track record of success.
  5. Excellent analytical and organizational skills.  
  6. Excellent verbal and written communications skills.

Resumes can be submitted to Debbie.strawser@lindnercenter.org.  

To learn more about the Lindner Center of HOPE, please visit our website at www.lindnercenterofhope.org.  

 

5-17-2018 - Director of Payor Relations & Contracting

Cincinnati Children’s Hospital is conducting a search for a Director of Payor Relations & Contracting responsible for the planning, development, direction and maintenance of outside third party payor and provider contracting relationships.  The Director will exercise general day- to-day supervision over Payor Relations department staff engaged in contract negotiations with third party payors. Lead negotiator for major health plans and other third party payors’ contract negotiations.

Additional responsibilities include:

  • Partners with Revenue Cycle Management and other CCHMC management, to negotiate favorable contract terms for professional, hospital, ancillary, and other services for CCHMC and the PHO.  Assist in developing and implementing annual contracting plan through individual contract negotiations and directing efforts of contract negotiation staff for CCHMC and PHO.

 

  • Reviews and analyzes all fee schedules for appropriateness and compliance.  Recommends annual fee changes and pricing policies. Develop analytical reports to demonstrate financial impact of proposed arrangements for physician, hospital and PHO contracts.

 

  • Monitors and continually evaluates third party payor contracts in conjunction with staff, AVP, and VP- Revenue Cycle. Track, monitor, evaluate, and distribute changes to medical/reimbursement/prior authorization policies and requirements that are distributed by third party payors.

 

  • Develops and maintains appropriate working relationships with the decision-makers and operating/clinical departments of various third party payor products and insurance companies.  

 

Ideal candidates will have a Bachelor’s degree in Healthcare Administration, Business, Finance, or related discipline plus minimum ten years of related experience, including 2-3 years of proven financial and third party payer contracting experience. Supervisory experience in a complex organization.  Experience with PHO, professional, ancillary, and hospital negotiations in an academic medical center required. Strong Analytical skills to analyze fee schedules and other reimbursement methodologies compared to our billed charges and/or costs.

Cincinnati Children’s Hospital, a nonprofit academic medical center established in 1883, and is one of the oldest and most distinguished pediatric hospitals in the United States. We offer comprehensive clinical services, from treatments for rare and complex conditions to well-child care. In the 2017-18 U.S. News & World Report survey of best children’s hospitals, Cincinnati Children’s ranked No. 3 among all Honor Roll hospitals.

Resume and cover letter may be sent to nancy.leyritz@cchmc.org or you may apply on our career center at:  http://jobs.cincinnatichildrens.org/us/en-us/Job-Details/Director-of-Payor-Relations-Contracting-Job/Vernon-Manor/XjdP-jf858-ct104566-jid83199304.

 

5-17-2018 - DIRECTOR, FINANCIAL SERVICES – Cincinnati, Ohio

The Director of Financial Services will serve as a critical member of the leadership team and hands on manager.  This position will oversee fiscal operations of the Cincinnati facility, working in conjunction with local hospital administration/managers, a local board, plus corporate offices.  Responsible for managing accounting, business office functions including financial analysis/reporting and ensures financial transactions meet state, federal, and corporate requirements, and functions in a leadership role for revenue cycle.  Must have excellent interpersonal skills and a solid background in the hospital industry with Revenue Cycle in an acute care hospital and have hands on management/supervision experience. Prior experience with Lawson accounting software a bonus.  Full-time position, Monday-Friday, regular business hours. Requires a bachelor’s degree in accounting, finance, business administration or comparable related degree. A master’s degree is highly desirable. Minimum 7 years accounting experience in hospital or not-for-profit setting.  Minimum 1 year supervisory/management experience. Comprehensive Benefits.

SUCCESSFUL CANDIDATES WILL BE REQUIRED TO PASS COMPETENCIES FOR ALL POSITIONS.

THOSE WHO ARE NOT IMMUNE TO CHICKENPOX WILL BE VACINATED.

SHRINERS HOSPITALS FOR CHILDREN IS AN EQUAL OPPORTUNITY EMPLOYER

AND A DRUG FREE, SMOKE FREE WORK PLACE.

Please check out our web site at www.shrinershospitalsforchildren.org

Apply online at “Career Center”for more information about Shriners Hospitals for Children

Or email your resume directly to careerscin@shrinenet.org with job title in the subject line.DIRECTOR, FINANCIAL SERVICES – Cincinnati, Ohio

04-20-2018 - Billing Specialist

Billing Specialist

Job Summary

Brief Description:

The Specialist of Billing performs all billing, correspondence, and scanning activities across the organization. Job duties include, but are not limited to, managing client billing and ensuring procedures are billed according to contracts, reviewing and updating client statements as necessary, printing and mailing all paper and secondary claims, scanning documents to patient accounts, and reviewing correspondence and following up as needed. They will perform these duties while meeting the mission and goals of the organization, as well as meeting the regulatory compliance requirements.

Essential Functions:

  • Billing Specialists responsibilities include managing client billing and ensuring procedures are billed according to contracts, reviewing and updating client statements as necessary, printing and mailing all paper and secondary claims, scanning documents to patient accounts, and reviewing correspondence and following up as needed.
  • Performs other duties as assigned

Qualifications: 

  • Required: 1-2 years experience hospital billing.
  • Experience in hospital operations, compliance and provider relations preferred.

Hours

Full time hours, 40 hours/week.

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

About Us

This position will be a part of the revenue cycle team at Ensemble Health Partners – a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.

http://mercy.ttcportals.com/jobs/2415163-billing-specialist#

 

04-20-2018 - Clinical Denial Nurse

Clinical Denial Nurse:

Job Summary

Clinical Denials Nurse:

The Clinical Denials Nurse performs all denials activities across Ensemble Health Partners.

Job duties include, but are not limited to, contacting insurance companies to determine reasons claims are unpaid, correcting and resubmitting claims in a timely manner to ensure payment, identifying trends in denied payments by insurance companies to remediate issues, and identifying changes with insurance company policies to ensure compliant billing.

Qualifications – Minimum

 

  • Active RN or LPN license in the state of Ohio required
  • 2+ Years of experience in a direct patient care setting or similar position
  • Case Management or Utilization Review experience strongly preferred
  • Understanding of Revenue Cycle including admission, billing, payments and denials preferred
  • Knowledge of patient insurance process and requirements preferred

Hours

Full-time, 40 hours per week, 8:00 a.m. to 4:30 p.m.

Salaried position.

Must possess a current Ohio nursing license.

 

#LI-POST

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

About Us

 

This position will be a part of the revenue cycle team at Ensemble Health Partners – a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.

http://mercy.ttcportals.com/jobs/2399010-clinical-denials-nurse#

 

04-20-2018 - Customer Service Specialist

Customer Service Specialist

 

Job Summary

Customer Service Specialist:

Brief Description:

The Customer Service Specialist performs all customer service and collection activities. Job duties include, but are not limited to, answering patient questions regarding statements, posting guarantor payments, setting up payment plans within our policies, researching and resolving issues with accounts that have been identified by patients, reaching out to appropriate departments to resolve any requests made by patients, connecting patients with financial counseling department for charity screening, communicating patient balances, meeting collection goals as set by department, and providing excellent customer service for all of our patients.

Responsibilities:

  • Customer Service Specialists responsibilities include answering patient questions regarding statements, posting guarantor payments, setting up payment plans within our policies, researching and resolving issues with accounts that have been identified by patients, reaching out to appropriate departments to resolve any requests made by patients, connecting patients with financial counseling department for charity screening, communicating patient balances, meeting collection goals as set by department, and providing excellent customer service for all our patients.
  • Performs other duties as assigned

Qualifications:

  • 1-2 years experience in healthcare.
  • 2 year Associates Degree
  • Combination of post-secondary education and experience will be considered in lieu of degree
  • Experience in physician and hospital operations, compliance and provider relations. Customer Service and Call Center experience preferred.

#CB#

Hours

Full-time hours, 40 hours/week

Day Shift, 9:30am-6:00pm

Equal Employment Opportunity

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

About Us

This position will be a part of the revenue cycle team at Ensemble Health Partners – a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.

http://mercy.ttcportals.com/jobs/2415162-customer-service-specialist#

 

04-20-2018 - Revenue Recovery Manager

Revenue Recovery Manager

Job Summary

The Underpayments Manager oversees all revenue recovery activities across Ensemble Health Partners.

 

Job duties include, but are not limited to, understanding insurance contract terms, reviewing underpayments to determine if additional payment amounts can be requested, identifying trends in payment discrepancies amongst payors and reporting trends to management, auditing correct payment amounts to ensure accuracy of contract, and working with contract management to identify opportunities when negotiating contracts with payors.  In addition, the Manager will be responsible for ensuring new Specialists are hired and trained, answer questions posed by team members under his or her supervision, and work with the Director on any reporting requests or special projects while overseeing day-to-day operations of the team. They will also perform administrative functions related to evaluations, rewarding and disciplining staff as appropriate, and time management.

 

Manager responsibilities include operationalizing workflows around insurance contract terms and overseeing: 1) the review of underpayments to determine if additional payment amounts can be requested, 2) identifying trends in payment discrepancies amongst payors, 3) auditing correct payment amounts to ensure accuracy of contract. They also work with contract management leadership to identify optimize variance identification and offer feedback to Managed Care when negotiating contracts with payors.

 

Under the direction of the Director Revenue Recovery, assists in design of, implements, and oversees day-to-day workflow and operations of payment variance and underpayments from contract modeling and closed balance audit referrals; revisiting and revising when necessary for best practice performance.

 

Performs tasks related to onboarding, training, assisting, evaluating, disciplining, and professionally developing Underpayment Specialists.

Identifiies and coordinates ad hoc reporting or project requests and provides subject matter expert perspective on issues related to variances and underpayments for the Ministry.

Performs other duties as assigned.

Qualifications – Minimum

Required Minimum Education: 4 yr Bachelors degree; Specialty/Major: Business or relevant discipline

Licensure/Certifications:

Required: Certified Revenue Cycle Representative (CRCR) or Certified Revenue Cycle Professional/Executive-Insitutional (CRCP-I/CRCE-I)

Preferred: Certified Managed Care Specialist (CSMC)

Minimum Qualifications:

Minimum Years and Type of Experience: 3-5 years experience in acute revenue cycle; 1-2 years management experience

Other Knowledge, Skills and Abilities Required: High-level problem solving

Other Knowledge, Skills and Abilities Preferred: Experience in physician and hospital operations, compliance and provider relations.  Managed Care contracting experience preferred.

Hours

Full-time, 40 hours per week, days, 8:00 a.m. to 5:00 p.m.

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

About Us

This position will be a part of the revenue cycle team at Ensemble Health Partners – a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.

http://mercy.ttcportals.com/jobs/2414397-revenue-recovery-manager#

04-20-2018 - Manager, Vendor Management

Manager, Vendor Management

Job Summary

The Manager of Vendor Management is responsible for the follow-up activities on outsourced patient accounts needed by the department including no response activities as well as the performance and effectiveness of the department.  The Manager will be responsible for implementing short and long-term plans and objectives to improve revenue and account resolution. Additionally, he/she will be responsible for working with the vendors to identify reasons for delayed collections and resolution opportunities.   He/She will empower staff to develop methods of process improvement, including planning, setting priorities, conducting systematic performance assessments, implementing improvements based on those assessments and maintaining achieved improvements.

Manages all the follow-up activities on outsourced patient account performed by the Vendor Management department.  Responsibilities include contacting vendors to determine reasons for delayed collections and account resolution, working with the staff to better his/her understanding of the patient account life cycle and correcting any issues with patient accounts to facilitate payment, providing additional information as requested by vendors and/or insurance companies to ensure timely payment of claims, identifying trends in delayed or denied payments by insurance companies to remediate issues and ensure timely payments when billed, maintain on-going reconciliation process on outsourced patient accounts and facilitate the improvement of account resolution on outsourced patient accounts.

Collects, interprets and communicates vendor performance data using various tools and systems, while also using this data to make decisions on how to achieve performance goals.  Works with internal and external customers to make key decisions, impacting either the organization as a whole or an individual patient.    Works closely with ancillary departments to establish and maintain positive relations to ensure revenue cycle goals are achieved.

Responsible for interviewing, hiring, staffing, performance management and development of staff.  Counsels and disciplines employees when necessary in accordance with department and/or organizational policies.  Develops, updates and implements job standards, job duties, departmental policies and performance appraisals for all areas of responsibility.

Develops and manages departmental budget.  Prepares monthly reports as requested.  Establishes departmental goals with the staff to optimize performance and meet budgetary goals while improving operations to increase customer satisfaction and meet financial goals of the organization.

Assists in strategic planning and performs ongoing process improvement evaluation.  Reviews, updates and implements policies and procedures to support the vision and goals.

Performs other duties as assigned

Qualifications – Minimum

Minimum Education:

4 year Bachelors degree in Business or a related discipline.

* Combination of post-secondary education and experience will be considered in lieu of degree.

Minimum Years and Type of Experience:

Three years management experience in Healthcare industry.

Experience in physician and hospital operations, compliance and provider relationships.

Hours

Full-time, 40 hours per week, days, 8:00 a.m. to 5:00 p.m.

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

About Us

This position will be a part of the revenue cycle team at Ensemble Health Partners – a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.

http://mercy.ttcportals.com/jobs/2383815-manager-vendor-management#

04-17-2018 - Denials Senior Specialist

Job Summary

The Senior Denials Specialist performs all denial and audit activities.

Job duties include, but are not limited to, contacting insurance companies to determine reasons claims are unpaid, correcting and resubmitting claims in a timely manner to ensure payment, identifying trends in denied payments by insurance companies to remediate issues, identifying changes with insurance company policies to ensure compliant billing, communicating with other departments to resolve denial issues and submitting appeals in a timely manner.

Denials Sr.Specialist responsibilities include coordinating audit activities, contacting insurance companies to determine reasons claims are unpaid, correcting and resubmitting claims in a timely manner to ensure payment, identifying trends in denied payments by insurance companies to remediate issues, identifying changes with insurance company policies to ensure compliant billing, and submitting appeals in a timely manner.

2 years applicable experience strongly preferred in the following revenue cycle areas: billing  AR follow-up  denials & appeals  compliance  and/or provider relations.

Performs other duties as assigned

Minimum Education:

High School Diploma or GED

Preferred Education:

2 year / Associates Degree

Minimum Requirements:

2 years applicable experience strongly preferred in the following revenue cycle areas: billing, AR follow-up, denials & appeals, compliance, and/or provider relations.

Hours

Full-time, 40 hours per week, days

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

04-17-2018 - Contract Modeling Specialist

Job Summary

The Contract Modeling Specialist is responsible for developing, testing and maintaining expected reimbursement rules to accurately post expected reimbursement in the host system at time of billing.

The Contract Modeling Specialist combines in depth healthcare knowledge and technical and analytic skills and financial skills to ensure all aspects of a contract are implemented and managed throughout the life of the contract. Coordinates with other departments to ensure that expected reimbursement rules are up-to-date and accurate. Maintains a schedule of key update dates for expected reimbursement rules, such as Medicare OP quarterly updates, yearly Diagnostic Related Group (DRG) updates, and yearly increases for the Managed Care contracts. The Specialist is also responsible for accurate identification of payment variances. Through this identification, the Specialist helps feed underpayment workflow and resolution and also coordinates with Managed Care to resolve issues of contract interpretation affecting rate schedules.

Uses modeling tools to identify and confirm validity of payment variances for referral to the underpayments team for appeal and/or follow-up. Additionally, coordinates with Managed Care on issues regarding interpretation to resolve with payors to mutual agreement.

Qualifications – Minimum

Required Minimum Education: 4 year Bachelors Degree, Specialty/Major: Business or relevant discipline

Minimum Years and Type of Experience: 4-5 years experience in healthcare industry

Other Knowledge, Skills and Abilities Required: Knowledge of managed care organizations, contracts, and products.  Thorough knowledge of, and ability to apply, applicable policies and regulations governing managed care organizations and third party reimbursement plans. Requires a high level of problem solving ability, initiative and judgment. Requires the ability to work in a fast paced environment balancing multiple priorities and utilizing resources aggressively. Requires the ability to understand and interpret all aspects of a contract with an emphasis on the implementation and operational components of contract terms. Must be a self-starter with the ability to identify, understand, research, and solve unique and complicated financial and operational provider issues as it relates to their specific contracts.

MS Office Tools, EPIC Proprietary software application such as 3M, Excellent interpersonal skills are necessary to develop strong working relationships with internal and external contacts.

#LI-POST

Hours

Full-time, 40 hours per week, days

Equal Employment Opportunity

It is our policy to  abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.

04-17-2018 - Manager, Health Information Management

The Health Information Management Department Manager is responsible for the day-to-day operations of the Southern market. This includes recruitment, planning, organizing, staffing, oversight, orientation, ongoing training and evaluating, coaching and development of all HIM staff. This individual is also responsible for all HIPAA duties.  Works collaboratively with the Director, other members of the management team, as well as the Operational Systems Analyst to develop and implement short and long term goals which support the Health Information Management Department, and Mercy Revenue Cycle initiatives.

Plan, direct, organize, train and monitor all activities of the HIM area, and, in conjunction with other members of the Health Information Management Department management team, monitor other areas of the department on an as needed basis. This includes promoting a harmonious working relationship with a high level of productivity and an atmosphere of teamwork. Provides the necessary leadership, direction and documentation to effectively supervise and motivate staff and promote the ‘team’ approach to problem solving and goal setting. This includes interviewing and recruiting qualified staff and the development of staffing schedules and assurance of proper coverage always.

Works with members of the medical staff, other ancillary departments, Administration, Legal/Risk Department, and Human Resources, as well as HIPAA Privacy Officers for other covered entities within our Mercy network, to provide, knowledge and education related to all HIPAA regulations. Carries out all duties required of a HIPAA Privacy Officer, to include creation and updating of HIPAA policies and procedures, assuring such policies are communicated within the market, investigation of all alleged HIPAA breaches, tracking such allegations, and reporting and communicating breaches as required by law to patients and the Office of Civil Rights, Department of Health and Human Services of the federal government.

Maintains current knowledge of all department policies and procedures, Medical Staff Rules and Regulations, market and system-wide policy and procedures, time keeping and payroll practices, HIPAA regulations and standards associated with the Center for Medicare and Medicaid Services and The Joint Commission.

Prepares and conducts regular update meetings and educational sessions for staff. This includes regular HIM staff meetings as well as providing educational presentations related to the HIPAA rules for internal staff within the medical center and the market, as well as outside organizations upon request. This involves serving on various committees at the local and system-wide level.

Responds to demands of external and internal requesters, such as medical staff members/offices, risk management, Administration and other hospital departments in supplying reports and data to support quality patient care.

Develops and maintains policies and procedures related to HIM which incorporate applicable legal, ethical and accrediting standards. Assures system-wide HIPAA policies and procedures are incorporated in the local market.

Timely completion of staff orientation, quality reviews, coaching, corrective action, Touch Bases and Performance Evaluations. In addition, revise and update Job Descriptions for staff under his/her direction.

Maintains quality and quantity standards, productivity, statistical reports and communicates findings on a regular basis.

Works closely and collaboratively with the Director and other managers to develop, implement, and monitor short and long term goals which support the strategic initiatives of the department, local market and system. Develop and communicate action plans when goals are not achieved.

  • 3-5 years’ experience in an Acute Care Hospital’s Health Information Management Department with a minimum of 2 years’ experience as a Lead, Supervisor or Manager
  • 2 year/Associates Degree in Health Information or a related field at minimum; 4 Year/Bachelor’s Degree in Health Information or related field preferred
  • Registered Health Information Technician, (RHIT) Registered Health Information Administrator, (RHIA) Certified HIPAA Privacy Officer preferred
  • Excellent written and verbal communication skills with the ability to communicate complex rules and findings to multiple parties, while complying with required guidelines and timeframes required
04-17-2018 - AVP Pre-Access

Job Summary

The AVP of Pre-Access manages overall Pre-Access performance, initiatives, projects, and procedures.  They manage the Pre-Access leadership team to ensure quality with associate performance, associate engagement/turnover, documentation, and front end denials.  The AVP is responsible for managing overall projects including Pre-Access centralization efforts, system implementations, and new processes.

The AVP of Pre-Access will manage overall performance of Pre-Access including denial reduction efforts, quality, process improvement, additional service line offerings, physician outreach, employee engagement etc.

The AVP of Pre-Access will manage projects for Pre-Access including system implementation, centralization efforts, and new process implementation.

The AVP Pre-Access will ensure documented procedures exist and communication occurs via the Training department as needed for consistent Pre-Access performance.  Routine meetings and educational efforts will be logged and tracked in a shared drive or hub environment.

The AVP of Pre-Access will identify trends through denial and reject review and work to implement sound processes with Pre-Access.  They will communicate expectations for decentralized areas in regards to these processes.

The AVP of Pre-Access will communicate routinely with senior leadership regarding updates, KPI indicators, ROI of process improvement, and any trends that need to be addressed.

All other duties and projects as assigned.

Qualifications – Minimum

Required Minimum Education: High School Diploma or GED

Preferred Education: 4 year Bachelors Degree

Specialty/Major: Finance or Administrative degree preferred.

Licensure/Certifications:

Required: Certified Healthcare Access Manager (CHAM) certification within 6 months of hire date.

Preferred: Certified Revenue Cycle Representative (CRCR) within 6 months of hire date.

Minimum Years and Type of Experience: 5 years within a Revenue Cycle, Patient Access, or Pre-Access environment.

Other Knowledge, Skills and Abilities Required: Must have experience in a fast-paced work environment, and can work on multiple projects simultaneously.

Other Knowledge, Skills and Abilities Preferred: Microsoft Office

04-17-2018 - Financial Clearance Specialist

Financial Clearance Specialist – Collections Specialist – Health Care Call Center

At Mercy Health, we are seeking active, engaged, and enthusiastic team members who want to work closely with patients and care givers in a non-clinical role. A Financial Clearance Specialist / Collections Specialist is a vital member of the healthcare team, and is responsible for providing world class customer service to clients.

Financial Clearance Specialist Responsibilities include:

  • The Financial Clearance Specialist I provides world-class customer service while exceeding the expectations of scheduled patients for cost share/liabilities prior to the date of service.
  • The Financial Clearance Specialist assigns insurance plans accurately
  • Performs electronic eligibility confirmation and documents results
  • Calculates patient cost share/liability and attempts to collect via phone within 48 hours of the date of service.

Financial Clearance Specialist will receive benefits:

  • Competitive compensation and benefitspackages that reflect our commitment to providing fair and just workplaces.
  • Wellness programmingdesigned to help our associates enhance their health, including a comprehensive annual health risk assessment.
  • A culturetruly participatory and to strengthen diversity and inclusion.
  • Growth-Once you’ve joined our team, you will discover a variety of traditional and online learning opportunities, including tuition reimbursement, to help you acquire new skills and obtain degrees, certifications and CEUs. And our managers will coach you toward greater success.
  • Recognition-We recognize our associates through programs that include service awards, celebrations and personal appreciation. We also survey associates annually to assess their satisfaction with our organization and managers, and to identify areas for improvement.

Financial Clearance Specialist Requirements include:

  • HS Degree Required – Associates Preferred
  • Minimum of 2 years working in a call center with collection experience
  • Articulate, personable, dependable and confident with excellent communication skills.
  • Customer service oriented, builds trust and respect by exceeding customer expectations.
04-17-2018 - Underpayment Specialist

Job Summary

The Underpayment Specialist performs payment variance activities related to the incorrect processing of claims.

Job duties:

Include, but are not limited to, understanding insurance contract terms, reviewing underpayments to determine if additional payment amounts can be requested, identifying trends in payment discrepancies amongst payors, auditing correct payment amounts to ensure accuracy of contract, and working with contract management to identify opportunities when negotiating contracts with payors.

Underpayment Specialists responsibilities include understanding insurance contract terms, reviewing underpayments to determine if additional payment amounts can be requested, identifying trends in payment discrepancies amongst payors, auditing correct payment amounts to ensure accuracy of contract, and working with contract management to identify opportunities when negotiating contracts with payors.

Underpayment Specialists receive their work from variances validated through the contract management software or the closed balance audit process. Items are referred to them for follow-up and collection via appeal or reconsideration.

Qualifications – Minimum

Required Minimum Education: 2 Yr. Associates Degree, specialty/major: Business or relevant discipline

Minimum Years and Type of Experience: 1-2 years experience in healthcare industry.

Skills and Abilities Preferred: Experience in physician and hospital operations, compliance and provider relations.  Managed Care contracting experience preferred.

03-09-2018 - Regional Director of Reimbursement - Ohio

TRINITY HEALTH

JOB DESCRIPTION

REGIONAL DIRECTOR, REIMBURSEMENT (OHIO)

REPORTS TO:  Vice President, Reimbursement & Revenue Integrity

LOCATION:  Columbus, Ohio

POSITION PURPOSE

The Regional Director of Reimbursement serves as the primary contact to the Regional Chief Financial Officer along with the Regional Health Ministry (RHM) Vice Presidents of Finance and the Regional Ambulatory Services Leadership to provide them with an understanding of their business, net revenue estimates, balance sheet valuations, net revenue budgets, mid-month projections and regulatory changes. The role provides critical help to the Vice Presidents of Finance in understanding their business so appropriate and timely decisions can be made.  The incumbent provides leadership to a Regional Shared Service Center managing the reimbursement function for up to ten Trinity Health RHMs (with net revenues of $2 billion annually). The position is responsible for managing and mentoring all Shared Service Center managers and staff and is also required to manage the relationships between the Shared Service Center and RHM Vice Presidents of Finance.

This position identifies and manages all financial and compliance risk associated with the reimbursement function, keeping senior leadership apprised of identified risk and tracks progress with risk management plans.  It works closely with and supports other revenue functional areas including payer negotiations and contracting, patient financial services, utilization management and coding. It serves in an advisor capacity to RHMs in region and to the Reimbursement and Revenue Integrity Central Operations Team.  The role identifies and implements leading practices, processes and technology necessary to achieve objectives and engage key stakeholders by leading effective change management.  Responsible for leading and participating in initiatives to improve net revenues, reduce receivables and improve compliance associated with the Southeast Michigan professional (ambulatory) services.

ESSENTIAL FUNCTIONS

  1. Knows, understands, incorporates and demonstrates the Trinity Health Mission, Vision and Values in leadership behaviors, practices and decisions.
  1. Prepares the department budget and manages use of resources within budget targets.
  1. Responsible for hiring, retaining, evaluating, mentoring and firing managers and staff within the department.
  1. Responsible for managing all financial and compliance risk associated with the reimbursement function (for acute and professional services), notifying senior leadership of identified risks and tracking and monitoring progress of risk management plans.
  1. Directs the preparation of RHM net revenue calculations and reviews with the Vice Presidents of Finance prior to financial statement due date. Directs the preparation of the budgeted net revenue calculation for the RHMs.
  1. Manage the overall balance sheet position related to third party contractuals and related reserves.  Provide updates to Senior Leadership to avoid any surprises.
  1. Directs the preparation of RHM cost reports and other third party filings.  Directs the preparation for third party audits and takes a lead role in resolving audit issues and developing appeals. Directs the preparation of reports, position papers, impact analysis and development of recommendations concerning specific reimbursement issues. Participates in developing group appeals for all Trinity Health concerning reimbursement disputes with third party payors.
  1. Develops strategic reimbursement planning and analysis for short and long-term operating plans and capital projects (for acute and professional activities).
  1. Provides financial planning assistance to Regional Chief Financial Officer and RHM Vice Presidents of Finance and Ambulatory leadership relative to current reimbursement practices and proposed changes in both the public and private sectors and provides the Leadership with the latest updates on changes in reimbursement regulations. Provides direction in the development of reimbursement strategies that reflect changes in the reimbursement environment.
  1. Develops and implements policies and procedures to ensure reimbursement procedures, practices and reporting adhere to compliance regulations.
  1. Directs reporting process and reconciliation of general ledger accounting for third party payments and settlements, including third party payor receivables, payables and reserves.  Responsible for matters which include areas of policy development and ongoing reporting.
  1. Provides education and consultation to staff to ensure accuracy of third party reporting.  Maintains expertise in reimbursement strategies through appropriate educational and organization activities.
  1. Directs year end audit preparation for reimbursement issues ensuring the continued integrity of financial records through the design and implementation of appropriate controls.
  1. Participates in RHM management and staff meetings to provide reimbursement support.
  1. Represents RHMs when reporting to and dealing with external agencies such as the Centers for Medicare and Medicaid Services (CMS), third party payors, federal regulatory agencies and other health care entities regarding reimbursement practices, policies and regulations.

 

  1. Promotes change in public and private sector policies and procedures in order to optimize the performance of RHMs while maintaining consistency with the Trinity Health mission and values. Involvement in various association task forces that develop policy recommendations, such as the Michigan Hospital Association.
  1. Participates in the negotiation, implementation and ongoing review and monitoring of contracts with third party payors and managed care entities.
  1. Maintains functional accountability to the Trinity Health Vice President of Reimbursement to ensure accurate and timely reporting, consistency of methodology, adherence to compliance programs and sharing of best practices across Trinity Health.
  1. Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

LEADERSHIP COMPETENCIES   

As a Trinity Health Leader, the incumbent is expected to demonstrate leadership traits which support our Mission Statement and Core Values as identified below: 

Mission Statement:  We, Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Core Values:

  • Reverence:  We honor the sacredness and dignity of every person.
  • Commitment to Those who are Poor:  We stand with and serve those who are poor, especially those most vulnerable.
  • Justice:  We foster right relationships to promote the common good, including sustainability of Earth.
  • Stewardship:  We honor our heritage and hold ourselves accountable for the human, financial and natural resources entrusted to our care.
  • Integrity: We are faithful to those we say we are.

MINIMUM QUALIFICATIONS

  1. Bachelor’s degree in Business Administration, Accounting or Finance or an equivalent combination of education and experience. Master’s degree is preferred.
  1. Certification as a Certified Public Accountant (CPA) preferred.
  1. Over ten (10) years of progressively more responsible experience in health care reimbursement management.  Experience managing multiple facilities preferred.
  1. Ability to develop and interpret financial statements and reports.
  1. Working knowledge of generally accepted accounting principles and a thorough understanding of third party reimbursement mechanisms and contracting strategies.
  1. Ability to communicate in clear, concise terms with management and governance at all levels, including communication with C-Suite executives.
  1. Ability to work effectively in a matrix organizational structure and influence others.
  1. Well-developed conceptual and analytical skills.
  1. High level of interpersonal, management and organizational skills are necessary with special focus on customer service orientation skills.
  1. Must be able to operate effectively in a collaborative, shared leadership environment.
  1. Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS

  1. Flexibility to work with a multitude of customers and issues and willingness to take on new responsibilities.
  1. Ability to develop constructive alternatives and analyze situations and information.
  1. Ability to work well in a fast-paced setting that warrants varied and/or extended hours, with frequently changing workload and priorities in order to keep pace with the environment and advance strategic priorities.
  1. Operates in an office environment free from hazards and barriers. Manual dexterity is needed to operate a computer and calculator.
  1. Must be able to set and organize own work priorities, and adapt to them as they change frequently.
  1. Must be able to adapt to frequently changing work priorities, and be able to prioritize and balance the requirements of working with the System Office and Regional Health Ministries (RHMs).
  1. Must be able to travel to the various Trinity Health sites (20%) as needed (may or may not apply).