How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Job Summary:

As an accomplished revenue cycle expert, you will undertake a key leadership role supporting all front end and back office revenue cycle processes which enable the WellStar Health System Region to achieve its overall strategic and financial goals by continuing to drive best practice and optimal RCM performance. The WellStar Health System is comprised of 11 Hospitals, Health Park HOD's, Clinics and over 700 WMG Physicians.
This position will plan, organize and direct all aspects of the functions of the Hospital and HOD's Business Service activity to ensure timely, legally compliant, and accurate billing while maximizing the cash flow related to the collections of Account Receivable for all WellStar Health System Hospital locations. This includes all insurance and patient billing, insurance follow-up, cash management, credit and refunds, cash applications, and payment variance management. This position will work closely and in collaboration with the Patient Access Center, Coding and Clinical Documentation Improvement, and Revenue Integrity.

Core Responsibilities and Essential Functions:

Operations and System Integration
- Provide operational direction and leadership for areas of the Revenue Cycle assigned, including hospital billing/follow-up cash management, revenue integrity, denials,payment variance, credit/refunds, and cash applications.
- Develop plans and oversee system-wide efforts to improve key performance metrics, including though not limited to, timely and accurate billing, high volume cash collections, reduction to total AR balance, reduction to bad-debt expense and timely cash application processes. Develop and maintain policies, procedures and work instructions aligning functional teams and leadership around these goals; in accordance with legal and regulatory requirements.
- Build sustainable results and performance improvement that support business strategy through consideration of the needs and challenges faced by the RCM Team coupled with a clear understanding of the priorities, focus and emergent issues of other functions and teams across the enterprise.
- Partner with Finance and Accounting to ensure a seamless financial close of source systems. Outline clear procedures, stakeholders and communication channels to complete RCM close activities. Plans accordingly for the impact to Reimbursement and RCM functions resulting from initiatives, business trends or catalysts.
- Work with Business Analytics and Finance teams to build, test and roll out enhanced metrics. Conduct scheduled reviews of key performance metrics around financial, activity and quality indicators to identify, communicate, and address performance gaps through team involvement in root cause analysis and design and implementation of well-reasoned permanent solutions.
- Maintain, update as appropriate, and enforce the adherence to Revenue Cycle and system written policies, procedures, and processes.
- Develop and monitor productivity and quality metrics and benchmarks for each area of the Revenue Cycle based on industry standards. Monitor productivity and quality of each area using metrics and provide feedback to management regularly (monthly as a minimum).
- Oversee the discharged, not final billed (DNFB)/unbilled accountablity structure for claim and billing edits.
- Work closely with the WellStar Connect team to ensure an effective implementation of new billing systems, identify opportunities for system or process improvements with WellStar Connect and beyond, and drive change through targeted initiatives.
- Report and review key metrics and progress on outstanding initiatives to the Assistant Vice President of Revenue Cycle on a regular basis.
- Proficiently use all systems and processes applicable to the job.
- Managed vendor contractual relationships, including validation of performance, deliverables and contractual obligations.
- Initiate, managed and complete assigned project, project management and systems integration requirements
- Oversight from a business owner perspective of RCM organization, functions, systems and procedures. Driving organizational productivity gains through process re-engineering, best practice bench-marking, and focus on continuous improvement.
- Perform other duties and responsibilities as assigned

Required Minimum Education:

Bachelor's Degree BA in Business, Accounting, Finance Required or
related field. Required and
Master's Degree in Health Care Administration, Nursing, Preferred or
Business Administration Preferred or
equivalent Preferred

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):



Required Minimum Experience:

Minimum 5+ years of progressive leadership including director level responsibility in a complex healthcare organization, Revenue Cycle experience.
Required and
Exposure to billing and reimbursement for infusion, Medicare and Medicaid reimbursement, Commercial & Managed Care claims, Workers Comp, and other Specialty Policies; substantial understanding of rejection codes, varied appeals levels, and appropriate response plans when working with government or commercial payers.
Required and
Exceptional interpersonal skills for written, verbal, presentation, and computer communication
Required and
Exceptional business acumen including experience in contracting or group purchasing
Required and
Experience with leading integration or other large transformation projects
Preferred and
Minimum 10 years hospital and physician accounts receivables experience
Preferred

Required Minimum Skills:

Knowledge of state and federal regulations as they pertain to billing processes and procedures.
Knowledge of insurance claim processing and third-party reimbursement.
Knowledge and detailed understanding of all negotiated agreements.
Knowledge of the principles of Information Systems in order to effectively analyze and make decisions..

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.