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Director, Account Receivable Escalation Unit

Facility: CHS Services Inc Location: Melville, NY Department: Revenue Cycle Administration Category: Leadership Schedule: Full Time Shift: Day shift ReqNum: 6017559

Catholic Health Services of Long Island (CHS) is an integrated health care delivery system with some of the region's finest health and human services agencies. CHS includes six hospitals, three skilled nursing facilities, a regional home nursing service, hospice and a multiservice, community-based agency for persons with special needs. Under the sponsorship of the Diocese of Rockville Centre, CHS serves hundreds of thousands of Long Islanders each year, providing care that extends from the beginning of life to helping people live their final years in comfort, grace and dignity.

Position Summary:

The Director of the Revenue Cycle Accounts Receivable Escalation Unit will be responsible for managing underpaid insurance balances that are unable to be resolved through routine follow up activities. He/she will provide leadership and oversight of key operational and financial decisions pertaining to the resolution of open underpaid insurance balances. The Director will report to the Vice President, Revenue Cycle Management for CHS, and develop and maintain a collaborative relationship with the Directors of Managed Care and each Hospital CFO/Finance Leader and other key stakeholders.

Responsibilities:

  • Identify and communicate potential process improvements.
  • Quantify and communicate trends in payer activity.
  • Coordinate and manage weekly, bi weekly and monthly payer calls.
  • Responsible for validation of contracts as loaded in contract management systems.
  • Responsible for validating and reporting any rate load issues identified.
  • Coordinate follow up activities with payers.
  • Coordinate rate analysis for recycling.
  • Oversees the validity, integrity and completeness of revolving spreadsheets.
  • Coordinates the preparation and validation of settlement files and any files requested for arbitration proceedings or litigation.
  • Identify opportunities for improvement targeted at the reduction in underpaid claim balances.
  • Coordinate with key stakeholders across the revenue cycle organization on the management of third-party underpayments and identify trends and implement payment integrity and underpayment prevention and/or recovery programs.
  • Develop, implement, and oversee efficient and effective operational policies, processes and tools.
  • Maintain a high level of proficiency in payer contract provisions to ensure analysts are properly identifying valid underpayments.
  • Responsible for managing engagements with vendors engaged in activities related to insurance recoveries and underpayments.
  • Create a work environment for employees through team building, coaching, constructive feedback, work delegation, personal example and goal setting that encourages creativity, open dialogue on work issues, professional growth, and a consistent, high level of performance. Encourage decision-making within their scope of responsibilities.
  • Provide leadership to direct reports and advise on financial, operational, and human resource related issues.
  • Identifies training needs for bot individuals and teams. Facilitates training/education in line with identified needs and skill levels.
  • Perform ongoing performance reviews and annual assessments of direct reports.
  • Identify, implement, and monitor compliance with revenue cycle leading practices as they pertain to key business functions.

Requirements and Qualifications:

  • A Bachelor's degree from a recognized college or university in business, finance, healthcare administration, or a closely related field required however, equivalent skills and experience may be considered.
  • Strong preference for a Master's degree in business administration, health administration, or a closely related field.
  • The successful candidate is expected to possess a minimum of (8) years of hospital revenue cycle management or managed care experience. Expertise in hospital billing and collection process including CMS/Medicare regulations is required. Knowledge of Epic billing systems a plus.
  • Superior analytical and problem solving skills.
  • Excellent written, verbal communication and interpersonal skills.
  • Time management and organizational skills.
  • Self-directed with the ability to work with various stakeholders and teams.
  • Ability to make quality, independent decisions as well as the ability to collaborate effectively to make decisions with other leaders.
  • Ability to work effectively and efficiently under tight deadlines, high volumes and multiple interruptions.
  • Proficiency with Microsoft Office (Word, PowerPoint, & Excel).

At Catholic Health Services of Long Island your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.

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