Corporate Director, Billing Optimization

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation's leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

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The Corporate Director of Billing Optimization is responsible for the strategy, management and implementation of the Enterprise Billing Program, actively owning the portfolio across Revenue Cycle Management and drive optimization and improved metrics across the clearing houses. The Director will partner with revenue cycle and business office leaders across all levels of the organization to execute goals and plans of reach / exceeding key performance indicators (KPI) relating to billing operations, which include but are not limited to: 837 files, billing edits, clean claim rate standards, billing errors and trends, as well as claim rejections and trends. Through strategy development, aligning the annual initiatives and collaboration, the Director will lead improvement efforts through execution of business objectives and strategic initiatives. The Director will provide issue resolution, develop and implement standard operating procedures (SOP) when needed, participate in go-live implementations to ensure successful transition, as well as provide effective communication and stakeholder management at all times. The Director is accountable to the VP of Outsourcing and Strategic Initiatives for timely reports and updates relating to key initiatives, delivering successfully on timelines, as well as effective management of staff and delivery of appropriate productivity and quality parameters if the Director has direct reports.

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EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

Bachelor's degree (B.A.); a minimum of 8-10 years related experience and/or training; or equivalent combination of education and experience.
1. Five (5) years of experience with acute hospital/ facility revenue cycle setting.
2. Prior working experience within Supervisory/ Management capacity, specifically with Billing Integrity, Revenue Integrity, and Billing Process, includes managing the billing for all payors, includes managing bridge routines.
3. Prior experience in implementing clearing houses and preferably rollout of EPIC program in a large hospital setting.
4. Ability to envision and execute; process and policy changes, change in corporate culture, alignment between enterprise strategy and individual business channel needs.
5. Proven ability to effectively interact with key stakeholders, hospital leadership and other team members, while maintaining standard of professional business service
6. Strong communication and relationship management skills.
7. Ability to form collaborative working relationships.
8. Strong analytical and problem-solving skills. Ability to review weekly, monthly metrics - leading and lagging KPIs and own action plans. Proven ability to make logical correlations between data points to determine if analysis is accurate.
9. Ability to envision and execute; process and policy changes, change in corporate culture, alignment between enterprise strategy and individual business channel needs.

Preferred qualifications:

1. Proficiency with IT hospital revenue cycle tools like CHC / Relay Assurance (also known as ePremis, now part of Optum), EPIC, Meditech.
2. Advanced knowledge and management of bridge routine files - writing and modifying, CCI edits, 835, EFT, ERA, and claim error trends across multiple payor base and across states.
3. Meditech and EPIC: basic navigation of systems as a minimum.