Director, Revenue Cycle and Finance, Affiliation Model The Director of Revenue Cycle and Finance will be responsible for coordinating all provider revenue cycle activities, as well as all financial management, planning, analysis and reporting activities for the primary care affiliation model practices. Coordinates activities with respective operations, administrators, general accounting, patient accounting, finance and other related departments. Coordinates with the Athena management team on all revenue cycle activities and reporting. In partnership with the Sr Director of Operations, assists with developing and assuring compliance with all provider billing and coding workflows at the practice. Reports directly to the CFO of Inova Medical Group. Responsibilities:
Responsible for coordinating all provider (MDs, PAs, NPs, etc.) revenue cycle activities for the affiliated model physician revenue streams.
Develops, maintains and updates to improve the workflow of physician charge generation and processing activities.
Coordinates with practice managers and Athena to insure that all systematic workflows are in place relating to scheduling, co-pay collection, outstanding balance collection, charge capture, coding, refunds, and self-pay A/R management.
Develop and/or maintain physician (et al) charge masters assuring appropriate coding and market-level pricing.
Develop and recommend performance targets. Monitor and be responsible for making recommendations for improvements.
Responsible for assuring billing procedures are in compliance with government regulations and standards. Develop communication plan for billing company, physicians and support staff for updates in regulations.
Coordinates activities with respective Operations, Administrators, and General Accounting, Patient Accounting, Finance and other related departments. Coordinate routine physician education sessions.
Responsible for overall coordination of operating and capital budgets (both annual and five-year) to assure a plan consistent with financial goals of Inova.
Oversees the coordination and preparation of annual operating plan to ensure consistency with Inova's goals, specifically maintaining all FTE and Salary Budgets.
Coordinate annual and five-year capital expenditure plan, involving facilities development, administration, and medical staff.
Ensures that department operations are in full compliance with accrediting and regulatory agency standards.
Ensures adherence to Service Excellence standards and provision of the outstanding customer service.
Sponsorship and Management of Revenue Cycle Projects. Responsible for ensuring the successful execution of Revenue Cycle projects, especially those relating to current or new system tools. Responsibilities include vendor selection and contract negotiation, project requirements definition and management of the Revenue Cycle components through the entire project lifecycle.
Develops and/or reviews project requirements, system design and process flows to ensure alignment with departmental and organizational goals.
Communicates project status to executive leadership.
Provides support for project implementation and post-live transition period.
Support and Optimize of Revenue Cycle Processes. Proactively identifies and advocates for opportunities to improve Revenue Cycle processes using business knowledge in collaboration with internal and external peers. Identifies systematic issues through collaboration and analysis and provides recommendations for process improvements.
Evaluates new systems and tools to ensure business needs are met and return on investment is achieved.
Provides recommendations and oversees implementation in the optimization of Revenue Cycle system utilization.
Technical Oversight of Revenue Cycle Systems.
Coordinates system upgrades with vendors and IT department.
Oversee management of key vendor relationships.
Assists in technical troubleshooting of system issues.
Oversees department's participation in IT projects and initiatives.
Works with IT to ensure that all systems are covered by Business Continuity plans.
Ensures system compliance with security and change control policies.
Ensures Internal Control systems are accurate and effective.
Reviews and evaluates systems and records of financial and statistical activity inclusive of accounting entries, information and reports.
Reviews and evaluates analytical models, journal entries and reports while cross checking to ensure appropriate data and alignment with organizational goals.
Reviews data and questions validity as appropriate to ensure completeness and accuracy.
Ensures a complete audit trails are available for accounting transactions and/or audits.
Performs comparative analyses of statistical and financial information.
Provides oversight to ensure accurate and timely completion of complex account reconciliations.
Responsible for revenue cycle analytics and for determining the root cause of performance issues and assisting with corrective actions. Serve as key participant on the revenue cycle leadership team and interface frequently with IMG CFO, Inova Health System Executives, and PFS teams.
Develop and maintain daily, weekly, and monthly revenue cycle reports used to provide guidance and insights to revenue cycle and finance leadership
Evaluate impact of metrics on daily, weekly, and monthly basis, providing strategic recommendations for improvement by functional area
Coordinate with other PFS leaders to support broader analyses that explain payer yield insights or support other revenue cycle initiatives
Oversees Athena's management of underpayments, responsible for ensuring yield maximization and for determining the root cause of operational and technical issues affecting payer reimbursements.
Set priorities and goals for underpayments team to ensure Inova employs the most effective approach to identifying, recovering and preventing underpayments based on the latest analytical tools and strategies available
Maintain monthly reports used to provide operational guidance to PFS Leadership and Managed Care
Partner with PFS Leadership and Managed Care to resolve ongoing underpayment issues with contracted payers
Create and manage the Athena contract to establish performance expectations and ensure Athena is meeting terms of contract as well as expected outcomes.
Meets regularly with vendor representatives to escalate patient account barriers and coordinate results between PFS staff and/or Managed Care Contracting leadership as needed
Create and distribute vendor reporting on weekly and monthly basis, evaluating vendor performance, and resolving vendor barriers to metric improvement
Coordinate timely escalation of agenda materials and ensure meeting minutes are documented for recurring and ad hoc meetings between Managed Care and PFS teams
Escalate and organize all relevant system barriers with Athena and related 3 rd payer vendor systems to enhance operational efficiency
Performs other duties as assigned
Internal Number: 36173BR
About Inova Health System
Inova is a global leader in personalized health, which leverages precision medicine to predict, prevent and treat disease, enabling individuals to live longer, healthier lives. At Inova, we serve more than two million people each year from throughout the Washington, DC, metro area and beyond. Inova's mission is to improve the health of the diverse community it serves through excellence in patient care, education and research. At Inova, more than 16,000 employees demonstrate their commitment every day to providing the community with expert, world-class, compassionate patient care.