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Job Details

SIDRA5003 - Revenue Cycle Consultant (6 Month Contract)

Department: Not Applicable
Division: Revenue Cycle Dept
Contract Type: Consultancy
Closing Date: 30-Apr-2020
Organizational Profile:

Sidra Medicine is a state of the art academic medical center that will function to the level of the highest international standards. Its clinical focus is on the specialty care of women and children.

Sidra’s Vision is: “Sidra Medicine will be a beacon of learning, discovery and exceptional care, ranked among the top medical centers in the world”.

Achieving this vision will encompass three essential activities:

World Class: Patient and Family Centered Care Health Education Biomedical Discovery

Department:

The Finance department will contribute to realization of Sidra’s vision by providing strategic direction, stewardship and excellence of service.

Finance includes the following core functional areas:

  • Financial Services
  • Reporting, Planning and Budgeting
  • Corporate and Treasury Finance
  • Patient revenue, billing and insurance

 

Finance provides services to departments across the organization and also works with external partners at both the operational and government level
JOB SUMMARY:

 

Responsible for the management and direction of the back-end revenue cycle processes and team. This includes the development, review and implementation of policies relating to billing, collections, cash posting, refunds and credit balances, denial management, bad debt, charity, and payer variance activities. It also includes the design and implementation of relevantly defined healthcare plans which, through collaborative working with IT, are effectively designed and built in Cerner and align with the organization’s Pricing Framework, as well as applicable standards, guidelines, current laws and regulations.
KEY ROLE ACCOUNTABILITIES: • Functional responsibility for the key departmental areas: Accounts Receivable (insurance claims and billing; patient financial counselling) and Revenue Integrity (Charge Description Master, System Contracts Management). 
• Ensures that a robust and effective range of policies and processes are in place related to the scope of the department’s responsibilities, reviewing existing policies and processes to ensure both fitness for purpose and alignment with best practice. 
• Directs the development and implementation of a range of accurate and reliable management reports that provide sufficient visibility of the key performance indicators at departmental level, including compliance with policy. These include but are not limited to: inappropriately coded information, healthcare plan allocation and subsequent switching, late charges, DNFB rates, claim denials, subsequent challenges and rejections, accounts receivable, debtor days, value of write-offs and/or lost income opportunities.  
• Ensures the daily monitoring of key performance indicators.
• Works with departmental Managers to ensure the timely identification and sufficient mitigation of underperformance in relation to departmental-related key performance indicators. This includes identification of performance trends and the subsequent determination of the root cause(s) of underperformance, both within and outside the department. 
• Directs the development and delivery of an annual performance improvement plan. 
• Leads performance and process management initiatives both within the department but also those that are affected by upstream and affect downstream processes. This includes provisional diagnoses coding and subsequent allocation to healthcare plans, cost of care estimation, coding accuracy, financial counselling, payer engagement, accounts receivable and claims settlement. 
• Directs the timely completion of billing cycle, accounts receivable day and aging, claims losses and bad debts, corrections required for successful operation of responsibility areas, relationship - internal and external.
• Ensures the timely and accurate submission of information to payers that ensures timely claims settlement.
• Directs the introduction and refinement of the structure and/or the associated definition(s) of the healthcare plans to which patient activity is allocated, ensuring that these are effectively communicated to relevant colleagues across the organization and, where necessary, training is provided.
• Ensures that the department works within the established pay and non-pay budget.
• Ensures the regular review of patient accounts that enables the timely identification and remedial plans for billing and processing issues.   
• Establishes and implements a system for the collection of delinquent accounts ensuring third-party payers are contacted.
• Oversees the Charge Description Master (CDM) and associated fee schedules to ensure strategic pricing goals for Sidra are achieved, ensuring appropriate maintenance and an annual review process is in place.  
• Participates in the planning of system upgrades and updates for operational needs, ensuring these are tested and implemented in a timely and accurate manner.
• Directs the development of revenue optimization opportunities. 
• Maintains knowledge of and complies with established policies and procedures including government, insurance and third-party payer regulations. 
• Attends meetings and participates in committees as requested.  Conducts special projects and studies as directed.
• Promotes and maintains excellent customer service relations with all key stakeholders and actively seeks ways to improve service quality.
• Participates in professional development activities and maintains professional affiliations.
• Maintains confidentiality in regard to patients’ accounts status.
• Adheres to Sidra’s standards as they appear in the Code of Conduct and Conflict of Interest policies
• Adheres to and promotes Sidra’s Values
Qualifications:

Bachelor’s Degree in Business/Commerce or relevant discipline.

10+ years of progressive management experience including 7+ years Director experience in patient revenue cycle/patient billing in a healthcare institution or healthcare company using electronic patient billing systems.

• Knowledge of Hospital patient billing systems, procedure classification system, complex Hospital patient billing methodologies, patient Insurance systems.
• Knowledge of business management and basic accounting principles to direct the business office.  
• Knowledge of computer accounting programs, spreadsheets and applications.
• Knowledge of medical terminology, coding and office procedures. 
• Knowledge of third-party and insurance company operating procedures, regulations and billing requirements, and government reimbursement programs.
• Knowledge of hospital policies and procedures, including but not limited to departmental policies, code of ethics, and dress code policy.
• Knowledge of the mission, ethics, and goals of the facility, as well as the focus statement of the department/department areas.
• Completes annual educational requirements.
• Understands complete revenue cycle of hospital.
• Skilled in establishing and maintaining effective working relationships with other employees, patients, organizations and the public.
• Skilled in developing, implementing and administering budgets.
• Ability to process patients and public inquiries and respond with poise and efficiency.
• Ability to recognize, evaluate, solve problems, and correct errors. 
• Ability to conceptualize work flow, develop plans, and implement appropriate actions.
• Ability to maintain confidentiality of sensitive information.
• Proficiency with Microsoft Office suite
• Fluency in written and spoken English

 

 

Other Information:

Contract Duration 6-12 months

Sidra’s Organizational Values:
  • Trust: Being competent; acting consistently, reliably and predictably; acting with honesty and integrity; respecting patient, employee and commercial confidentiality; delivering on commitments
  • Care: Acting with empathy, kindness and compassion; being humble; listening and responding; acting with cultural sensitivity; Caring for patients and staff
  • Teamwork: Sharing information and knowledge and learning from demonstrated expertise; being respectful, and thereby earning respect of others; acting with professionalism; leading and following; collaborating and being accessible
  • Transparency: Frequent and honest communication; open access to information for decision making; willingly acknowledge shortcomings; speaking up about concerns; publishing performance indicators
  • Innovation: Freedom to innovate; welcoming ideas and encouraging creativity; supporting talent; creating confidence; celebrating successes
  • Efficiency: Providing measurable value; using data to drive decision making; having and achieving clear goals; building processes that work; continuously improving outcomes in patient and family care
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