Associate Vice President, Hospital Central Billing Office

Finance & Revenue Cycle Worcester, Massachusetts


Position at UMass Memorial Health Care

At UMass Memorial Health Care, Everyone is a Caregiver regardless of title. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health care system of Central and Western Massachusetts, and a place where we can help you build the career you deserve. We are more than 14,000 employees, working together as one health care system. And everyone, in their own unique way, plays an important part, everyday.
Requisition #:  192337
Title:  Associate Vice President, Hospital Central Billing Office (CBO)
Department:   Fiscal/Revenue Cycle
Posting Date:  March 28, 2019
Status:  Exempt
Shift:  Days
Hours:  40
Location:  UMass Memorial Health Care – 306 Belmont St, Worcester, MA
Position Summary:
Under the guidance of the System Vice President for Revenue Cycle Operations, the Associate Vice President (AVP), Hospital CBO is responsible for ensuring timely, efficient, accurate and compliant hospital claim generation, accounts receivable and denial management, and balance resolution in accordance with governmental regulations, third party contracts, UMMHC policies and generally accepted patient accounting practices, for all UMMHC hospitals and in excess of $1.5 billion in annual revenue.
Position Qualifications:

  1. Bachelor’s degree in Business, Health Care Administration or a related field is required.
  2. Minimum 10 years’ experience working in a revenue cycle management/patient accounting role in a hospital or health system is required
  3. Demonstrated, in depth knowledge of patient accounting and accounts receivable management standards and practices
  4. Excellent communication skills including the ability to effectively summarize and convey difficult and detailed topics to senior leadership and build consensus around improvement initiatives.
  5. Demonstrated knowledge of and experience with clinical and revenue cycle computer systems. Epic clinical documentation/charging/coding experience is preferred.
  6. Strong computer skills (e.g., Microsoft Word, Excel, PowerPoint, Project, Visio)
  7. Minimum of five years’ experience in a supervisory/people management capacity
Major Responsibilities:
  1. Develops and oversees strategic and tactical plans in support of the Health Care System’s mission and vision, focused on ensuring timely, accurate and compliant claim submission and resolution for all Hospital services provided across UMMHC hospitals.
  2. Collaborates frequently with senior leaders of Hospital Finance/Revenue Cycle departments and clinical areas regarding any content or timing issues impacting the ability to produce and/or adjudicate clean claims.
  3. Ensures the timely and compliant resolution of any claim holds and edits that delay or prevent submission to responsible third party payers.
  4. Oversees the resolution of all Hospital Accounts Receivable on the billing system through subordinate Director(s), Management and staff, ensuring that claims are adjudicated by third party payers correctly and efficiently, in the context of frequently changing and disparate Federal, State and commercial billing guidelines.
  5. Oversees, through subordinate Director(s)/Managers and staff, the remediation of any claims denied by third party payers by either correcting the claim data elements causing the denial (if appropriate/compliant to do so) or adjusting the balance on the AR as a write-off or contractual adjustment.
  6. Oversees, through subordinate Director(s)/Managers, the development and ongoing maintenance of a sophisticated contract modeling system used to determine the reimbursement expected for each Hospital claim based on clinical services provided to each patient and the relevant insurance payment algorithms, contracts and regulations.
  7. Oversees a program of continuous improvement focused on the identification of receivable and denial issues, the determination of root causes, and the development of corrective action plans in collaboration with clinical and revenue cycle leadership.
  8. Collaborates with accounting and reimbursement leadership within Fiscal to ensure that the accounts receivable information included on UMMHC financial statements is correct and reliable based on industry standard patient accounting practices.
  9. Oversees the development and distribution of meaningful metrics and key performance indicators for UMMHC hospital entities to drive strategic analysis and decision making, and the identification of improvement opportunities.
  10. Oversees a large staff through subordinate Directors/Managers, ensuring performance standards are maintained, all regulations and policy guidelines are followed, and a spirit of engagement and front line problem-solving is fostered throughout the Department.
  11. Develops and manages operations against associated budgets to determine all spending is within budgetary guidelines
  12. Encourages and supports diverse views and approaches, creating an environment of professionalism, respect, tolerance, civility and acceptance toward all employees, patients and visitors.
  13. Ensures compliance to all health and safety regulations and requirements.
  14. Performs similar or related duties as required or directed.
All responsibilities are essential job functions.
We’re striving to make respect a part of everything we do at UMass Memorial – for our patients and for each other. We’re expecting that our new caregivers practice our six Standards of Respect: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player, and Be Kind, to help us make respect a part of how we take care of business everyday.