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.

  Basic Qualifications:

  Experience

• Minimum five (5) years in a revenue cycle role including experience with integrated healthcare delivery systems and multi-facility health systems.

• • Minimum of three (3) years of experience managing revenue cycle activities for hospital and/or large medical groups with a successful track record in process improvement, improved collections and meeting revenue cycle goals and benchmarks.

  Education

• Bachelors degree in business administration, finance, accounting, health administration or related field OR four (4) years of experience in a directly related field.

• High School Diploma or General Education Development (GED) required.

  License, Certification, Registration

• N/A

  Additional Requirements:

• Excellent working knowledge of revenue cycle operations and insurance benefit and product development.

• Demonstrated experience in patient financial services information systems, operations improvement and re-engineering and project management.

• Excellent communication skills (written and verbal) with the ability to manage both through direct reporting relationships as well as through influence and collaboration.

• Experience managing activities that lead to measurable and sustainable improvements in any of the following areas:

• Bad Debt Reduction, Business Office Billing and Collections Operations, Charge Description Master, Charge Capture, Denials Management, Clinical Documentation and/or Patient Admitting/Registration.

• Experience contributing to the development and maintenance of budget and operating plan for revenue cycle operations.

• Hospital/Professional based Coding and Billing experience.

• Possess the ability to analyze trends, develop and maintain performance goals and regularly provide information to senior management.

• Skilled in coaching, counseling and developing others to achieve operational objectives including teaching the fundamentals of revenue cycle operations and objectives.

• Skilled in team building, team participation and achieving organizational success.

• Possess advanced proficiency in all Microsoft computer applications (i.e., Excel, PowerPoint and Access) and other job-related networks and software.

• Possess extensive knowledge of general business concepts including financial management, organizational behavior and personnel/labor laws and regulations.

• Must be able to work in a Labor/Management Partnership environment.

  Preferred Qualifications:

• N/A.

COMPANY: KAISER

TITLE: Manager Regional Revenue Cycle Operations

LOCATION: Pasadena, California

REQNUMBER: 1320866

External hires must pass a background check/drug screen. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state and local laws, including but not limited to the San Francisco Fair Chance Ordinance. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran, or disability status.