Responsible for leading the application of the principles of the Clinical Appeals (RCBS) standards to continuously improve the processes. Accountable for assuring a process and resource allocation to achieve the goals and objectives. Responsible for assuring that standard, policies, procedures as well as our core values and mission are upheld. Assures that high performance work team is developed through coaching, mentoring and regular shift briefings. Responsible for the analysis of the performance metrics, improving process performance and overall change management.
Manage daily operations within Clinical Appeals
Ensures process and resource allocation is appropriate to meet business goals; keep senior leadership and others updated when there are situations that may impede business goals from being met
Proactively communicates updates, reports and feedback to senior leadership
Problem and issue identification and resolution
Work with all facilities, external vendors and other corporate departments to document new and existing policies, procedures and reports
Perform financial and procedural analysis to identify trends and problems and collaborates in the implementation of solutions
Interact with ministries and Clinical Appeals leadership to implement policies, procedures and systems and to gather and disseminate information
Proactively pursues knowledge to stay current with regards to health care compliance, denials, denial management, payor updates, regulations and contracts with CHRISTUS Health
Support the Director in the development of department, inclusive of helping to fill key positions and deploying the resources necessary to support the department
Assist Department in managing communicating efforts to business offices, Centralized Business Offices and other Corporate departments as well as advising them of process improvements along the revenue cycle
Manage the tracking and reporting project progress, providing necessary training or communications to facilities regarding operational improvements along the revenue cycle
Provide leadership and management of overseeing, identifying, developing and implementing tools, automation, reports and educational materials to support the interaction between the facilities, within Revenue Services, and other Corporate Departments
Help coordinate specific data needs and requests from and between the above-mentioned departments and facilities
Cultivate internal relationships at the corporate and facility level to gain support and participation in initiatives including ministries, PFS, Managed Care, Decision Support and other Corporate and ministry departments
Provide analysis capabilities, information and tools to operations to enhance skills in detecting both current and future performance issues
Any other duties or projects as may be necessary to effectively complete the duties of the position or as assigned by the Director from time to time
4 Year College Degree or equivalent hospital leadership experience required
Must have knowledge, or obtain knowledge within 90 days, on all major payor groups, including HMO's and PPO's, Medicare, Medicare Advantage, Medicaid and Managed Medicaid procedures for payment turnaround.
Excellent communication skills
Ability to successfully interact with associates and leaders within Revenue Cycle and other areas within CHRISTUS Health
Ability to lead cross functional teams, mentor and support the development of associates
Ability to report to multiple leaders
Must possess proven strong problem solving skills
Strong foundation of Revenue Cycle functions and denial management; or ability to transfer equivalent knowledge to quickly become proficient
Familiarity with management reporting, metrics and goal setting
Ability to work independently, achieve tight deadlines and take initiative on multiple projects
Ability to make sound decisions that are generally guided by CHRISTUS core values, mission and policies and procedures (or) escalate when needed
Requires proficiency with MC Office and other healthcare systems such as EHRs, claim systems, case management systems, imaging etc.
Years of experience, education and work performance of an internal Associate may be reviewed and considered for possible promotion into this position if the Associate has demonstrated knowledge of denials management and third party rules and requirements and RCBS principles and processes.
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.