The Director of Patient Service Contact Center Operations is responsible for strategic and operational leadership of the Patient Service Contact Center. This position contributes to the financial strength, compliance and overall performance of Revenue Cycle operations by providing leadership for all call center functions, including scheduling, nurse triage, pre-registration and financial clearance. The Director of Patient Service Contact Center Operations serves in a key role to monitor and facilitate improvement in the overall quality, timeliness, completeness, and accuracy of every patient call (such as registration, financial clearance, pre-service collections, and scheduling), as well as overseeing operational, regulatory and business activities of the Patient Service Contact Center.
The position will provide overall administration, direction, coordination, and evaluation of Patient Service Contact Center services and is specifically responsible for the following:
• Pre-Registration Services
• Nurse Triage (non-clinical components)
• Financial Clearance
• Financial Counseling
• Pre-service collections
• Prior Authorizations
• Data integrity
• Denial/Edit avoidance, mitigation and timely resolution
It is critical that this position be highly effective in delivering the services described above and work harmoniously with leaders and staff across the organization. Effectiveness will be measured in terms of measurable results, commitment, staff engagement and customer satisfaction (at all levels).
Job Functions and Duties:
1. Supervises daily operations in the Patient Service Contact Center. Ensures leadership proactively manages daily activities and holds staff accountable to defined standards and set unit metrics goals and key performance indicators.
2. Provides timely communication and conducts regular meetings with ambulatory clinics and hospital departments to provide progress and updates, and to discuss accountability metrics.
3. Trains and coaches Patient Service Center staff members and reviews dashboards and metrics both for internal customers and external customers.
4. Maintains performance and service level agreements. Sets accountability and goals and monitors performance of the Patient Service Contact Center staff against service level agreements.
5. Initiates, maintains and monitors appropriate staffing for the Patient Service Contact Center and escalates necessity for staffing changes to the Senior Director of Revenue Cycle Operations.
6. Provide strategic direction and oversee the operation and process design of systems and procedures to ensure efficient functioning of Patient Service Contact Center.
7. Ensure development of industry best practice operating procedures with consistent application in all business units.
8. Ensure all compliance and regulatory standards are maintained.
9. Develop, monitor and manage operations utilizing industry metrics on a monthly, annual and long-range planning basis. Ensure development of metric report cards to quantify improvements in productivity, quality, service and overall financial results.
10. Serve as an internal consultant on pre-service issues including 501(r), pricing transparency, compliance with payer contracts, and any other pre-service regulatory or contractual requirements.
11. Active participation in denial mitigation and revenue preservation activities.
12. Set and achieve annual and periodic goals and key performance indicators in support of Patient Service Contact Center operations and overall financial performance.
13. Manage, prepare and present budgets that demonstrate prudent use of the organization's resources. Achieve planned results for Patient Service Contact Center operations.
14. Ensure effective coordination with Senior Director of Revenue Cycle Operations and other Revenue Cycle Directors to achieve financial and service level goals for the Patient Service Contact Center business units as well as Central Maine Healthcare.
15. Ensure effective communication and coordination with other functional areas to achieve desired service levels.
16. Participates in drafting and final approval processes for Patient Service Contact Center policies and procedures.
17. Collaborates with patient service leaders to ensure that pre-service and patient facing processes are working effectively, efficiently and accurately.
18. Evaluate appropriate and key outsourcing partnerships such as financial resource assistance.
19. Monitor and support daily staff functions in all areas related to the scope of the director's responsibility.
20. Ensure strong technology functionality to support all elements of Patient Service Contact Center as it relates to revenue cycle and interfaces with clinical and other operational areas. Examples are eligibility, price estimation, registration quality, scheduling and prior authorization tools.
21. Communicates with other leaders to establish accountability and coordination between Patient Service Contact Center and other departments.
22. At the direction of the Senior Director of Revenue Cycle Operations, provide formal reports and presentations to management teams, physician groups, external businesses and consumer groups.
23. Assist with special analysis and projects as needed.
24. Provide leadership support at all supported entities within CMH.
25. Seek and recommend new information technology solutions and or manual changes that support Patient Service Contact Center departmental functions.
26. Work collaboratively with departmental personnel to implement systems and process changes aimed at improving Patient Service Contact Center performance.
27. Ensure compliance with outside regulatory requirements are documented (i.e. 501(r))
Management Reporting and Monitoring
28. Review and analyze on-going Patient Service Contact Center KPI's based on computer generated data and manual reports.
29. Utilize departmental work plans to monitor initiative and project goals, progress, and outcomes.
Training & Education:
30. Work collaboratively with the Medical Group and other leaders to ensure consistency in patient experience for all patient facing locations related to Patient Service Contact Center.
31. Work closely with operational directors and managers to identify common areas of deficiencies and create training to correct the noted deficiencies.
32. Direct ongoing programs for staff development and training that foster and mentor the next generation of Patient Service Contact Center leaders. Establish goals with direct reports for organizational and personal development.
33. Attend local, regional and national conferences/seminars to remain current in supporting the needs of the organization.
34. Review industry publications to maintain knowledge base and stay current on best practice solutions.
35. Maintain current knowledge of regulatory developments involving agencies (CMS, AHA, DHS, and Joint Commission.)
36. Maintain certifications as applicable
37. Maintain membership with professional associations (HFMA, AAHAM, etc.)
Note: the duties listed above reflect the majority of the duties of this job and does not, nor is it intended to, reflect all duties that may be required for an incumbent in this job to perform.
Education and Experience:
• Bachelor's degree required. Eight (8) years progressive, relevant knowledge toward mastery in the field accepted in lieu of Bachelor's degree, and
• Ten (10) years of progressively responsible management level experience in a similar size and scope organization or system in Revenue Cycle.
Knowledge, Skills, and Abilities:
• Detailed knowledge of call center operations.
• Detailed knowledge of privacy and security regulations, confidentiality / HIPAA, payer registration /authorization requirements, State Charity Care compliance, and MaineCare compliance regulations.
• Working knowledge of Medical Terminology, Current Procedural Coding (CPT, HCPCS), Diagnostic Coding (ICD-9, ICD-10).
• Expertise with regulations and accreditation standards, knowledge of specific state and federal requirements and standards.
• Working knowledge of Medical Record, Access and Healthcare Application technology.
• Demonstrated experience in diagnosing, evaluating and developing corrective actions for problems in operations.
• Able to effect collaborative alliances and promote teamwork.
• Ability to ensure a high level of employee, patient, visitor, and external stakeholder satisfaction.
• Effective organizational, planning, controlling, scheduling and project management abilities.
• Effective managerial and administrative abilities as applied to the management of multiple projects.
• Effective leadership abilities.
• Ability to positively influence change.
• Excellent communications skills, both oral and written.
• Demonstrated ability to work well with diverse people, excellent human relation skills.
• Flexible and able to react to ever changing priorities.