PeaceHealth is seeking a Director Provider Based Billing for a Full Time, Day position.
Must be fully vaccinated for COVID-19 including 2 doses of a 2-dose series or 1 dose of a 1-dose series plus 14 days beyond the final dose prior to start date.
The Director of Provider Based Billing is responsible for the execution of the provider-based and rural health clinic (RHC) ambulatory strategy designed to support the organizational objectives for improved growth and care delivery. This position will be responsible for ensuring organizational regulatory compliance of existing provider-based clinics as well as identifying and directing the conversion of existing free-standing clinics to properly designed provider-based or rural health clinics.
- Provides operational oversight of the PeaceHealth provider-based and rural health clinic care delivery model. Works collaboratively with organizational compliance, legal, reimbursement, and billing resources to ensure all provider based and rural health clinic locations operate within regulatory guidelines. Serves as a resource to facility, reimbursement, and clinic operations on provider based and rural health clinic guidelines and operational best practices.
- Identifies operational regulatory changes in CMS requirements for provider-based and rural health clinics and directs corrective actions as appropriate. Works in collaboration with organizational integrity and compliance to perform and document annual compliance reviews for provider-based and rural health clinic locations. Develops KPIs for provider-based strategy and leads achievement of defined metrics in the areas of growth and care delivery.
- Recognizes ongoing opportunities to develop and expand provider-based and rural health clinic (RHC) status. Directs the design, development and operational implementation of new provider-based and rural health clinics through internal and governmental resources.
- Identifies regulatory changes in CMS requirements for provider-based billing and directs actions as appropriate to both hospital and professional billing. Guides Revenue Cycle and Finance on the billing and CMS reporting requirements for provider based and rural health clinics. Ensures compliance based on payer contracts and billing for provider-based specialties.
- Performs other duties as assigned.
QUALIFICATIONS Required unless otherwise stated
- Bachelor’s degree in business administration, finance, healthcare administration or related field.
- Previous experience with ambulatory clinic Operations, including Billing and Compliance.
- 7 years of progressive reimbursement/clinic operations/financial experience.
- 5 years of related leadership experience.
- Must possess knowledge about managed care and third-party contractual arrangements and can analyze such arrangements, including reimbursement and revenue.
- Excellent oral, written, presentation, and negotiation skills, with a demonstrated ability to manage a variety of projects under deadline in a fast-paced, complex environment.
- Ability to analyze and evaluate issues around provider-based reimbursement, including new and proposed locations, regulatory changes and the ability to write policy and procedure guidelines in a consistent and concise manner.
- Must be able to communicate effectively in English (written/verbal).
- Possesses extensive knowledge of the provider-based and rural health clinic rules.
SHARED SERVICES PHYSICAL/COGNITIVE REQUIREMENTS
- Work requires fairly light physical exertion from up to 65% of the time.
- Ability to lift objects weighing 30 lbs. or less.
- Work is performed under normal working conditions with adequate lighting and ventilation.
- Job duties frequently require intense concentration and attention to detail (up to 65% of work time).
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For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state, or federal laws.