• Job Description

  Req#: 1320866
  Job Summary:
  
  The Regional Revenue Cycle Operations Manager is a management position responsible for the operations success of a Regional Revenue Cycle business unit to include Medical Center and Medical Office Center Buildings (MOB). This individual is responsible for assuring the day to day operations in patient access revenue cycle processes supporting Kaiser Permanentes ability to enhance the patient experience and ensure the sustainability of the revenue cycle. Specifically, the Operations Manager is responsible for leadership and management of a Regional Revenue Cycle business unit(s) inclusive of: Medical Financial Assistance Program, including timely review and processing of applications and correspondence. Pre-billing and Billing operations, including management and oversight of work queues in KP HealthConnect to assist in cycle times within defined parameters. Professional Service Coding including management and oversight of work queues in KP HealthConnect (i.e., clearing of Ingenic edits). Late Discover/Subpoena/TPL operations including identification, validation and adding of coverage for Billable Payors, Kaiser Plans, Home Care and Workers Compensation. The Outreach Program, including pre-registration and customer service/member education functions. Eligibility Unit, including completion of pre-appointment eligibility verification for inpatient and outpatient services and responsibility for resolving related work queues.
  
  
  Essential Responsibilities:
  
  
  
  
  • Strategic Planning, Influence and Alignment:
  
  
  • Contributes to the strategic vision, process improvement plan and implementation strategy for a regional revenue cycle business model, including:
  
  
  • Pre-registration.
  
  
  • Eligibility verification.
  
  
  • Financial counseling and charity care administration.
  
  
  • Cost share collection.
  
  
  • Accurate and efficient charge capture.
  
  
  • Data quality monitoring, auditing and root-cause based feedback mechanisms; and training.
  
  
  • Provides day to day support in the development and execution of strategic vision and supporting initiatives as agreed to with the Directors of Billing Services and the Director of Eligibility and Financial Support Services.
  
  
  • Works in support of the Front Office Operations Initiative (FOOI) team on compliant point-of-service registrations and revenue capture internal controls.
  
  
  • Contributes input and data as needed to support the aforementioned directors in developing short and long-range financial plans, revenue cycle improvement plans, budgets, capital plans and business plan for the Region.
  
  
  • Management and Team Building:
  
  
  • Provides day to day operational and tactical management of staff and processes in the development of a Regional Revenue Cycle business unit in order to enhance patient experience and ensure sustainability of revenue cycle processes, including but not limited to:
  
  
  • Securing all technical and system resources.
  
  
  • Local business office work migration.
  
  
  • All other activities associated with creating robust, high-functioning regional business units.
  
  
  • Responsible for hiring, coaching, development, discipline and termination of staff as necessary.
  
  
  • Develops subordinates and establishes a climate for personal growth and development.
  
  
  • Identifies education and training requirements and works with leadership to develop effective training programs for immediate subordinates as well as their staff.
  
  
  • Leadership and Consultative Experience:
  
  
  • Serves as part of an internal consulting team regarding patient access issues including:
  
  
  • All regulatory and compliance requirements.
  
  
  • Statements of financial responsibility.
  
  
  • Cost share collection.
  
  
  • Patient privacy.
  
  
  • Medical financial assistance.
  
  
  • Supports the appropriate Director as liaison for the business unit.
  
  
  • Continually identifies opportunities for process improvement and implements them by engaging the appropriate Director to work with stakeholders.
  
  
  • Identifies and implements changes in legislation and accreditation standards that affect patient access and advises the appropriate Director on necessary responses to changes affecting patient access operations.
  
  
  • Leads Labor/ Management partnership initiatives within the business unit.
  
  
  • Coordination and Project Management:
  
  
  • Responsible for identification and implementation of key revenue cycle initiatives for the business unit.
  
  
  • Represents and acts on behalf of the Directors of Billing and the Director of Eligibility and Financial Support Services in numerous special projects and committees involving key regional and facility managers.
  
  
  • Manages and implements regional initiatives within the business unit, including identifying, assembling and managing necessary resources.
  
  
  • Metrics and Reporting:
  
  
  • Monitors operational performance on a daily, weekly and monthly basis to ensure patient insurance information is verified and entered correctly into the system, pre-certifications/ authorizations/referrals are obtained when necessary and patient financial obligations identified prior to service.
  
  
  • Provides input and data in the development of reports, forecasts and budgets for non-dues revenue (revenue associated with visits or admissions versus revenue associated with payment of premiums) and other defined areas of responsibility.
  
  
  • Compliance, Quality Assurance and Quality Control:
  
  
  • Supports the appropriate Director regarding the development of remediation plans to address identified control weaknesses.
  
  
  • Maintains day to day compliance with administrative/legal requirements and governmental regulations as it relates to revenue cycle centralized operations.
  
  
  • Any other Revenue Cycle functions.

• About the company

  Providing high-quality, affordable health care services and improving the health of our members and the communities we serve.

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