The Senior Director of Revenue Cycle and Managed Care (Senior Director} will be responsible for organizing Managed Care and Revenue Cycle initiatives, staff and resources to maximize revenue received by Cook County Health (CCH) for the provision of clinical services including inpatient care and outpatient services. The Senior Director will focus activities on internal program operations and collaboration with clinical and operational leadership. The Senior Director designs a system to support the patient's financial interface across the continuum of care, using best practices of cash collection and posting, registration, insurance verification, billing, and managed care reimbursement principles.
This position is exempt from Career Service under the CCHHS Personnel Rules.
General Administrative Responsibilities
Review applicable Collective Bargaining Agreements and consult with Labor Relations to generate management proposals
Participate in collective bargaining negotiations, caucus discussions and working meetings
Document, recommend and effectuate discipline at all levels
Work closely with labor relations and/or labor counsel to effectuate and enforce applicable Collective Bargaining Agreements
Initiate, authorize and complete disciplinary action pursuant to CCH system rules, policies, procedures and provision of applicable collective bargaining agreements
Direct and effectuate CCH management policies and practices
Access and proficiently navigate CCH records system to obtain and review information necessary to execute provisions of applicable collective bargaining agreements
Contribute to the management of CCH staff and CCH' systemic development and success
Discuss and develop CCH system policy and procedure
Consistently use independent judgment to identify operational staffing issues and needs and perform the following functions as necessary; hire, transfer, suspend, layoff, recall, promote, discharge, assign, direct or discipline employees pursuant to applicable Collective Bargaining Agreements
Work with Labor Relations to discern past practice when necessary
Using available data sources, designs a mechanism to collect, interpret and take action for program and process
Uses common improvement methodology e.g. Plan-Do-Study-Act (PDSA) to address programmatic areas not achieving performance
Investigates and evaluates approaches e.g. methodological, technical to improve efficiency and effectiveness for areas of
Supports the accurate translation of payer requirements (Governmental or Commercial) into workflows or
Provides periodic reports to senior leadership on selected aspects of revenue cycle, impact of process changes and opportunities to reduce cost or
Works across departments and wide range of staff to support revenue cycle goals.
Provides reports to clinical leadership on achievements and opportunities in the areas of documentation, charge capture and compliance with managed care requirements. Works collaboratively to identify
Supports the provision of answers to financial or benefit related questions that are consumer centric and
Understands and keeps current with changes in managed care third party reimbursement that may have an impact on revenues received and provides recommendations on
Provides day-to-day oversight and leadership to Patient Access, Revenue Cycle and Managed Care.
Oversees negotiation of payer and managed care contracts to ensure best outcomes for the system.
Monitors performance of approved managed care
Facilitates reporting for leadership that shows how the system is maximizing revenue while adhering to all regulatory requirements.
Ensures billing practices meet or exceed industry
Participates in discussions or activities regarding medical staff providing services at other institutions and will ensure this will provide maximal benefit to
Participates in discussions with external entities regarding partnerships or other joint venture activities to identify revenue generation activities that will be beneficial to the health
Performs other duties as assigned
Reports to the Chief Financial Officer, CCH
Bachelor's degree in business administration, health administration or finance from an accredited college or university
Seven (7) years of experience in financial management or administration for an integrated health system
Three (3) years of experience with third party billing related activities for Medicaid, Medicare and Commercial Managed Care contracts
Three (3) years of supervisory and/or managerial experience
Three (3) years of experience in a safety net or teaching hospital
Advanced proficiency In Microsoft Office Excel
Master's degree in Business or related field from an accredited college or university
Project management experience
Electronic Medical Record experience, such as CERNER or EPIC
Experience in Program or service implementation and performance improvement
Knowledge, Skills, Abilities and Other Characteristics
Knowledge of third-party billing related activities for Medicaid, Medicare, and Commercial Managed Care contracts
Knowledge of Healthcare and Family Services (HFS) regulations
Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
Demonstrate attention to detail, accuracy and precision
Demonstrate analytical and organizational, problem-solving, critical thinking and conflict management/ resolution skills
Ability to explain complex concepts to a diverse audience
Ability to support staff during periods of change and/or workflow
Ability to translate conceptual (e.g. new HFS regulation) into action plan for area of responsibility
Ability to organize priorities and workflows to meet deadlines and project targets.
Physical and Environmental Demands
This position is functioning within a healthcare environment. The incumbent is responsible for adherence to all hospital and department specific safety requirements. This includes but is not limited to the following policies and procedures: complying with Personal Protective Equipment requirements, hand washing and sanitizing practices, complying with department specific engineering and work practice controls and any other work area safety precautions as specified by hospital wide policy and departmental procedures.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.
For purposes of the American with Disabilities Act, “Typical Duties” are essential job functions.
Cook County Health is an equal opportunity employer.
Internal Number: Executive
About Cook County Health
ABOUT COOK COUNTY HEALTH (CCH)
The Cook County Health’s mission is to deliver integrated health services with dignity and respect regardless of a patient’s ability to pay; foster partnerships with other health providers and communities to enhance the health of the public; and advocate for policies that promote the physical, mental and social wellbeing of the people of Cook County.
CCH is comprised of two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital, a robust network of more than a dozen community health centers, the Ruth M. Rothstein CORE Center, the Community Triage Center, the Cook County Department of Public Health, Cermak Health Services, which provides health care to individuals at the Cook County Jail and the Juvenile Temporary Detention Center, and CountyCare, a Medicaid managed care health plan.
The system cares for more than 300,000 patients each year and its physicians are experts in their fields, committed to providing their patients with comprehensive, compassionate and cutting-edge care. Today, CCH is transforming the provision of health care in Cook County by promoting community-based primary and preventive care, growing an innovative, ...collaborative health plan and enhancing the patient experience.
COOK COUNTY HEALTH IS AN EQUAL OPPORTUNITY EMPLOYER