Details
 

08/24/2021

DIVISION MANAGER OF REVENUE CYCLE

Ohio Living Home Health & Hospice

DIVISION MANAGER OF REVENUE CYCLE

The Division Manager of Revenue Cycle ensures that certain functions occur within the third party revenue cycle for the home health, hospice, and other community based services through managing the Central Intake and Central Authorization Departments to facilitate accurate and timely information to enable timely starts of care, ongoing case management, and accurate billing in accordance with company standards and federal, state, and local standards, guidelines, and regulations.

Essential Activities and Tasks

Central Intake Management

  • Manages and understands all aspects for assigned Central Intake internal control process, including compliance with payer contract and administrative guidelines regulatory statutes and protocols.
  • Ensures that procedures, tasks, and functions performed by Central Intake staff are in accordance with prescribed processes and timelines with heavy emphasis on the sensitivity to preserving, establishing, and enhancing relationships with referral sources by processing referrals as expeditiously as possible without sacrificing accuracy.
  • Standardizes Central Intake performance protocols and workflows. Establishes, documents, and communicates expectations regarding productivity.
  • Establishes and documents Central Intake staffing structure. Establishes, documents, and communicates expectations regarding staff scheduling and on-call coverage since Central Intake is promoted to referral sources as available 24 hours per day and seven days a week, including holidays.
  • Develops, monitors, and supervises processes to ensure data integrity, including accuracy of patient data, third party payer data, eligibility for payer source coverage, and initial or preliminary authorizations, if required, that enables starts of care within a 48-hour timeframe from receipt of a physician’s order.
  • Gains command of the use of various software utilized for the referrals/admissions process.
  • Develops and conducts related training.
  • Ensures high level of customer service communication as well as timely action by Central Intake personnel with location sales and marketing staff, location administrative and clinical leadership, corporate operations leadership, and referral sources to enable starts of care within 48 hours of receipt of a physician’s order.
  • Ensures payer set-up data integrity through internal audits of insurance payer contracts and payer set-up parameters within the applicable software system.
  • Conducts monthly audits of product generated by Central Intake Coordinators for data integrity and completion.
  • Verifies all Central Intake-related issues completely then directs appropriate and timely activity to correct errors.
  • Performs assigned tasks of the Central Intake process as needed in a back-up/coverage role, on a limited basis, and/or coordinates back-up contracted temporary services if needed.
  • Communicates to appropriate staff all changes and updates to processes and procedures as required by regulatory agencies, third party payer contract amendments, or notifications to providers that affect Central Intake procedures.
  • Maintains user access requests to third party administrator portals to enable submission of authorizations and validation of patient-related eligibility for insurance coverages.
  • Ensures development and production of routine reporting that is communicated to corporate operations leadership on a prescribed frequency to enable monitoring of performance by the locations with an emphasis on timely starts of care.

Central Authorization Management

  • Manages and understands all aspects for assigned Central Authorization internal control process, including compliance with payer contract and administrative guidelines regulatory statutes and protocols.
  • Ensures that procedures, tasks, and functions performed by the Central Authorization staff are in accordance with prescribed processes and timelines.
  • Standardizes Central Authorization performance protocols and workflows. Establishes, documents, and communicates expectations regarding productivity.
  • Establishes and documents Central Authorization staffing structure. Establishes, documents, and communicates expectations regarding staff scheduling and on-call coverage for off-hours, weekends, and holidays.
  • Ensures accuracy and data integrity of authorizations obtained by Central Authorization staff, including patient data, third party payer data, and receipt of sufficient authorizations (i.e. number of days, number of visits, number of units, and date ranges) for new cases and continuing cases. This includes the accurate and timely data entry into the applicable software system.
  • Gains command of the use of various software utilized for the referrals/admissions process.
  • Develops and conducts related training.
  • Ensures monthly audits for data integrity, completion and timeliness of authorizations generated by Central Authorization Coordinators and Community admissions staff, Social Workers, or any other Community staff member assigned to obtain service authorizations.
  • Reports to and collaborates with corporate operations staff regarding any Community location performance issues pertaining to authorizations and re-certifications/reauthorizations.
  • Verifies all authorization issues completely then directs appropriate and timely activity to correct errors.
  • Performs assigned tasks of the Central Authorization process as needed in a back-up/coverage role, on a limited basis, and/or coordinates back-up contracted temporary services if needed.
  • Communicates to appropriate staff all changes and updates to processes and procedures as required by regulatory agencies, third party payer contract amendments, or notifications to providers that affect Central Authorization procedures.
  • Maintains user access requests to third party administrator portals to enable submission of authorizations and validation of patient-related eligibility for insurance coverages.

Revenue and Profitability Enhancement Support

  • Provides thought leadership in assessing current processes as well as developing alternative processes in an effort to improve efficiency and effectiveness within the Revenue Cycle internal control process. Leads and/or supports process change to ensure full implementation.
  • Works collaboratively with the corporate leadership to identify and corroborate opportunities with existing or potential funding sources and supports extended effort to attempt to secure those opportunities.
  • Works collaboratively with location staff and corporate operations staff to secure appropriate level-based reimbursement that coincides with the level of care provided. Trains, communicates, monitors, and routinely reports on performance.
  • Works collaboratively with corporate operations staff to identify, research, and validate other opportunities to secure appropriate reimbursement rates/amounts for services provided and supports action to ensure such reimbursement.
  • Supports data and reporting needs of the company officers and executives who are actively developing preferred provider relationships with physicians, hospitals, and other acute care upstream providers in an effort to pursue increased revenue volume. Collaborates with the corporate leadership to develop data reports or validate information.
  • Supports due diligence efforts to validate appropriateness of revenue cycle activities of potential partnerships, acquisitions, or other forms of business combinations as needed.

Financial and Operations Management

  • Assists the Chief Financial Officer, Corporate Executive of Finance, and/or other assigned accountants in monthly review and reporting of accounts receivable balances, development of adjustments to allowance for doubtful accounts, and assessment of bad debt trends.
  • Develops, prepares, and/or assigns the preparation of routine or special reports that are released to corporate and location leadership to enable awareness and determination of action.
  • Develops and presents performance data, updates to or clarity about technical requirements, and/or recommendations for process enhancements to certain corporate and location leadership to enable further thought leadership, process revision, and enhanced monitoring in an effort to improve financial performance.
  • Provides comprehensive support, in conjunction with corporate staff, with the training and performance monitoring of applicable location staff in the implementation and proper use of relevant Revenue Cycle, Central Intake and Central Authorization processes and procedures.
  • Communicates appropriately any staffing or location-specific issues.
  • Manages projects for assigned department prioritizing resources needed and completion timing.

People Management and Development

  • Supervises the Central Admissions supervisor and influences the work of the staff in the Central Intake and Central Authorization Departments.
  • Fosters a positive work environment that attracts, retains, and motivates employees.
  • Interviews, selects, and orients new direct reports.
  • Defines, establishes, and promotes performance expectations so direct reports understand and demonstrate excellence through high quality and consistent performance.
  • Evaluates job performance of direct reports in accordance with company policy and procedure and provides developmental guidance to staff for improved performance and growth.
  • Monitors accountability with organization requirements prescribed by the Employee Handbook. Documents and engages employees who are routinely not observing these requirements in an effort to achieve compliance. Works with Human Resources when circumstances arise that necessitate further documentation and intervention.
  • Participates in the development, planning, scheduling, conducting, and monitoring of training programs, including in-services, on-the-job training, external training, and orientation programs for departmental staff.
  • Responds timely and thoughtfully to questions, requests, and work product from departmental staff that has been provided for review and approval.

Data Integrity Process Support

  • Supports the identification of rate changes for Medicare, Medicaid, and other third-party funding sources. Assists Accounts Receivable Managers with oversight of accurate rate data entry identifiable to specific funding sources within applicable software systems. Advises on any particular funding source contract nuances pertaining to rates and reimbursement.
  • Supports Accounts Receivable Managers, accounting staff, IS staff, and vendors to resolve any software matters that may be inhibiting data accuracy and integrity.
  • Generates reports on a requested basis to enable assessment and communication with appropriate staff as needed.

Accounts Receivable Collections Support 

  • Informs and/or supports Accounts Receivable Managers in their understanding of new contracts, contract amendments, and workflow changes through Central Intake and Central Authorization that may affect billing and collections.
  • Supports Accounts Receivable Managers in identification of appropriate and timely action that resolves outstanding issues to ensure appropriate collection based on trending payer-specific issues as they arise, based on accounts receivable reporting metrics and internal audit outcomes.
  • Provides comprehensive support working collaboratively with Accounts Receivable Managers, Accounts Receivable Coordinators, the Corporate Manager of Managed Care, and location staff to identify, research, and/or resolve complicated contractual performance collections matters in an effort to secure payment and minimize account write-off and bad debt expense.
  • Supports the research and preparation of payer-related grievances and appeals in a timely and expeditious manner, escalating all large-scale issues to the appropriate channels and following through to resolution in collaboration with Accounts Receivable staff and corporate clinical staff as needed.
  • Establishes a process to capture and report the receipt of additional development requests or requests for other clinical documentation by funding sources in an effort to support services provided to claims billed.
  • Ensures timely communication and reporting to clinical operations leadership, submits response information when requested by clinical operations staff and continues to track and monitor status of corporate responses to funding sources and funding sources final determination by Central Authorization staff with collaboration between Accounts Receivable and corporate clinical staff.
  • Communicates with payers, governmental agencies, vendors, patients, residents, and other responsible parties to resolve problems or concerns.
  • Supports Accounts Receivable Manager and corporate clinical and operations staff in developing and sometimes presenting training information and material for Accounts Receivable Coordinators and site personnel in an effort to secure payment and minimize account write-off and bad debt expense.

All other duties as assigned.

Qualifications

Education

  • Bachelor's degree required.

Experience

  • Five years of experience with healthcare payor validation and securing payor authorizations for care, including staff supervision experience.
  • Experience with healthcare-related accounts receivable, billing, revenue, and collections operations supervision preferred.
  • Experience with accounts receivable, revenue, billing and collections operations for home health and hospice services preferred.
  • Proficiency with Windows, Microsoft Office (Word, Excel, PowerPoint), and the internet required.

To learn more about this exciting opportunity and to apply, go to www.ohioliving.org/careers.  

Ohio Living is among the country's leading comprehensive resources on aging well. Ohio Living Home Health & Hospice, a wholly owned subsidiary of Ohio Living, is one of Ohio’s premier providers of home health and hospice support for adults, wherever they live. Most importantly, we’re a company that:

  • chooses to operate as a faith-based, not-for-profit organization
  • makes its mission the heart of our organization
  • has a reputation for consistently exceeding the needs and expectations of those we serve
  • provides an engaging, team-oriented workplace dedicated to career, family and faith
  • commits to recognizing our employees for a job well done

We’re looking for people who:

  • have a passion for helping people, solving problems and contributing to a positive work environment
  • are excited about bringing their personal standards and ideals to work each day
  • understand that HOW you do your job is just as important as WHAT you do in your job

Why work at Ohio Living?

Depending on an employee’s full-time, part-time or PRN status, they may benefit from:

  • competitive wages
  • medical, dental, and vision insurance
  • 403b retirement savings
  • paid time off including your birthday
  • training, continuing education, and education assistance
  • pay advances up to $500
  • the latest technology
  • unlimited career opportunities
  • and much more!

Who is Ohio Living?

Headquartered in Columbus, Ohio Living is one of the nation’s largest not-for-profit, multi-site senior living organizations. Since its founding in 1922, Ohio Living has defined the highest standards of quality of life for adults through its 12 life plan communities and Ohio Living Home Health & Hospice in 50 Ohio counties.  

Our mission is to provide adults with caring and quality services toward the enhancement of physical, mental and spiritual well-being consistent with the Christian Gospel. 

Our Values: Care * Integrity * Customer Service * Innovation * Financial Stewardship * Leadership

 

 

 

 

Printer-Friendly Version



Our national partner, LeadingAge, is an association of 6,000 not-for-profit organizations dedicated to expanding the world of possibilities for aging. Together, we advance policies, promote practices and conduct research that support, enable and empower people to live fully as they age.