Providence Health & Services Director, Medicaid Billing and Follow Up in California
Providence St. Joseph Health is calling a Director, Medicaid Billing and Follow Up. This position works remotely and is open to candidates residing in Alaska, Washington, Montana, Oregon, California or Texas.
Applicants that meet qualifications will receive a text with an additional question from our Modern Hire system.
We are seeking a Director, Medicaid Billing and Follow Up who will have direct operational accountability for billing and follow up for regulatory payers, including Medicaid and Medicaid Managed Care plans, across all Providence acute ministries, including critical access hospitals, rural health clinics, provider based clinics and hospital based profee billing. Scope includes responsibility of annual cash collections of approximately $13B across acute hospitals in AK, CA, MT, NM, OR, TX and WA. Responsible for managing FTE's in multiple locations, as well as, remote caregivers. This role is responsible for executing a strategic plan to accomplish the goals for the Regulatory Lines of Business, in partnership with the leaders of Providence RCS Services.
This position is accountable for the development, operations and optimization of the Acute Regulatory Billing processes within Revenue Cycle (RC). This role includes working with key stakeholders across Providence; developing and executing strategic plans around Acute Regulatory Billing initiatives; participating in, leading, and partnering with others on RC strategic integration efforts; ensuring a compliant, effective, and streamlined operational experience for business and patient constituent groups. This leader, therefore, will need to have strong communication skills and leadership experience managing all areas in regulatory billing and follow-up. This position will have responsibility for participation in the leadership of the RCS managers to ensure Revenue Cycle activities are standardized across the Revenue Cycle departments in the health system, and that all policies, procedures, and strategies adhere to the guidance and vision of the centralized Revenue Cycle function.
Partners with the system level leadership on Revenue Cycle process improvement, training, technology innovation, analytics, compliance and vendor management. The Director of Medicaid Billing and Follow Up will continually review the current state and work with the AVP RCS, Executive Director of Regulatory Billing and Follow Up and other Providence Revenue Cycle leaders to move the organization to leading practices. The Director, Medicaid Billing and Follow Up is responsible to ensure policies and procedures are current and enforced, business practices are compliant, and a high level of patient and customer satisfaction is maintained across the region. Promotes an environment shaped by health, healing, hope, diversity, and mutual respect. Is self-directed and requires minimal supervision.
In this position you will have the following responsibilities:
Develop and maintain a well-trained and empowed staff to ensure timely and accurate account review and follow up, while achieving maximum reimbursement and recovery of AR. Develop a high performance team by coaching and mentoring staff, with an emphasis on responsibility and accountability. Recruit, select, orient and manage appropriate staff to ensure operational objectives are met. Ensure staffing levels are adequate to meet business outcomes and goals.
Implement, analyze and report on key factor reports for tracking and managing the performance of the department. Report proactively to the Executive Director, Regulatory Billing and Follow Up on any area not meeting standards established in the key factor reports and recommend appropriate changes.
Lead plan to improve the revenue cycle and to continually improve registration accuracy, clean claims ratios, coding accuracy, reduce days in AR, increase cash collections, reduce bad debt, eliminate write-offs due to revenue process issues and improve customer and patient satisfaction. Recommends claims billing and follow up AR goals and objectives in performance, production, quality and compliance.
Provide shared operational leadership to all ministries in the organization related to acute lines of business. Provide shared leadership and supervision to the areas of oversight.
Partner with other Revenue Cycle leadership to lead the development and implementation of policies, procedures and workflows which impact net revenue cash flow or performance efficiency across the Revenue Cycle function that align with the strategic direction and standardization for all of PSJH.
Partner with system wide Revenue Cycle leadership to develop process improvement opportunities, training, technology innovation, analytics, compliance and vendor management to meet acute Revenue Cycle needs. Manage and oversee the development of technology solutions to improve efficiencies and reduce the delays in workflow processes.
Collaborate with other PHS ministries and provides leadership in communicating consistent information and data regarding performance.
Collaborate with PHS Contracting to understand contract specifics and provide PHS Contracting with data to support negotiations with payers and development of contracting strategies. Develop relationships and collaborate with leaders at the payer level to improve appeal turnaround and dispute resolution.
Develop and ensure that all activities of the Revenue Cycle are performed in accordance with state and federal regulations, mandated collection practices, all regulatory agencies including JCAHO, and are HIPAA compliant.
Develop and monitor an annual operational budget as well as any capital budget requests, and complete all fiduciary responsibilities.
Actively collaborates with the financial leaders across PHS to ensure the goals and strategic initiatives are aligned and whenever feasible, operational procedures are standardized. Responsible to achieve annual performance goals as established by the Chief Revenue Cycle Officer for PHS.
Required qualifications for this position include:
Bachelor's Degree in Business, Healthcare Management, or related field -OR- equivalent education/experience.
10 years related experience in healthcare, revenue cycle or finance; 8 years leadership experience.
Preferred qualifications for this position include:
- MBA or MHA -OR equivalent education/experience.
About the department you will serve.
One Revenue Cycle (ORC) is the name adopted to reflect the Providence employees who work throughout Providence in revenue cycle systems and structures in support of our family of organizations across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. ORC’s objective is to ensure our core strategy, One Ministry Committed to Excellence, is delivered along with the enhanced overall patient care experience (know me, care for me, ease my way) by providing a robust foundation of services, operational and technical support, and the sharing of comprehensive, relevant, and highly specialized revenue cycle expertise.
We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Non-Clinical Director/Executive
Other Location(s): Montana, California, Washington, Oregon, Texas, Alaska
Req ID: 302634