Director, Billing and Collections

The mission of The University of Texas MD Anderson Cancer Center is to eliminate cancer in Texas, the nation, and the world through outstanding programs that integrate patient care, research and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees and the public.


 

The primary purpose of the Director, s for Hospital Billing and Collections is to manage and coordinate daily operations, which consists of billing all technical UB-04 claims with gross revenues in excess of $12 billion and cash collection in excess of $5.3B.  Expectation that billing volumes and cash collections will increase year-over year between 3-10 percent and that people, processes and technology are evaluated with increased volume.  In addition, this position is responsible for insurance collections from governmental, embassy, managed care, commercial payors, client account and specialty billing (i.e., cellular therapy).  This includes the evaluation and appeal of both clinical and technical denials.   Position ensures that all processes within HB Billing and Collections are measurable for productivity, compliance, and quality standards.  This position collaborates with all operating units in PBS and several multidisciplinary personnel to ensure proper handling, monitoring and oversight of the accounts receivable.    Position will also be responsible for tactical and strategic system design and automation opportunities.

 

Key Functions

 

• Manage and coordinate the hospital billing functions and processes associated with the billing for all services utilizing the current patient accounting system; including selected aged trial balances for hospital accounts as well as specialty follow up for special handling, Single Case Agreements (SCA), company billing, etc.  Ensure monitoring and oversight for of days in accounts receivables and aging greater than 90 days and other industry standard key performance indicators.  Compare business office metrics to HFMA MAP and EPIC Financial Pulse and asses our people, process, technology to maximize throughput, accelerate cash collections and enhance the patient experience.

• Evaluate, monitor and trend denials, including communication to Financial Clearance Center, Revenue Operations and Coding (ROC), Patient Access Services, Health Information Management, Managed Care, Case Management and other departments as appropriate.  Oversee the workflow and productivity of appeal related to denials.  Serve on the Denials Prevention Committee and collaborate/serve as subject matter expert to institutional denials efforts. 

• Oversight of Embassy and international payor AR and collaboration with the International Patient Center and Financial Clearance Center to ensure appropriate financial communications and access.  Evaluate monthly reports and ensure prompt feedback to embassy and institutional representatives regarding account status.

• Assist in designing and implementing revenue cycle systems as deemed necessary; assess current processes and metrics for transition to new systems; collaborate with IT on system initiatives.  Including system updates and leveraging automation opportunities.  

• Responsible for coordinating with IT to ensure all electronic edits are current and revised as required. Actively participate in the review of patient accounting system upgrades prior to placing into production; Coordinate testing of any system implementation or enhancement that will impact billing and collections.

• Responsible for clinical denials workload processing by team of RNs and oversight of insurance payor audit RNs for inpatient hospitalization and high dollar (greater than $100K) outpatient services retrospective accounts.  Provide guidance on complex clinical appeals. 

• Collaborate with HIMS & ROC to ensure coding work processes promote timely and accurate billing

• Collaborate with Clinical Research Finance to ensure throughput for accounts in clinical research review to expedite accurate and timely billing.

• Responsible for reviewing, researching and implementing where appropriate all regulations/changes related to governmental and non-governmental billing as well as any contractual requirements.  Responsible for advising all billing/follow up staff of all changes in billing regulations/requirements.  Coordinates the distribution of the same information to Financial Clearance Center, all Patient Access Centers and other clinical departments to include New Patient Referral, Case Management, Registration and Admitting.

• Must be knowledgeable and remain up to date regarding CMS (Centers for Medicare and Medicaid Services) billing regulations, Managed Care Payor Coverage Policy Bulletins, and other regulations/guidance to evaluate the impact to PBS operations (accounting and customer service) and implement/test any changes as appropriate.  This information should be communicated to the appropriate parties in PBS, Financial Clearance Center, Managed Care, Clinical Revenue and Reimbursement, Case Management, Patient Access Services, Revenue Capture and Support, Health Information Management and other departments/operating units throughout the institution as appropriate.

• Must ensure compliance of reporting according to Generally Accepting Accounting Principles and ensure financial controls are in place and monitored in compliance with Sarbanes Oxley standards.  The Director Patient Billing and Collections must be prepared to assist with preparing documentation as requested by both internal and external auditors to validate financial status of accounts, reconciliation processes and reasonableness of accounts receivables.

• Review weekly and monthly departmental overall productivity as it relates to work in progress, penalty requests, backlogs and payor trends, Monitor quality of work and management staff productivity for all assigned areas.

• Oversight and preparation of Medicare CMS-838 Outpatient Credit Balance Reporting.

• Collaborate with Institutional Compliance and Payment Posting and Credits on corrected claims and refund processing for time-sensitive compliance projects.

• Develop budget and control expenditures for HB billing and collections.

• Ensure departmental processes and procedures are documented and current.

• Responsible for ensuring staffing for the department to include hiring, counseling, evaluations as well as providing recommendations regarding staffing requirements to the Associate Vice President, Patient Business Services.  Ensures timely action on disciplinary or production matters and follows Human Resources guidelines. 

• Mentors’ management team and staff.  Performs succession planning for manager.

• Serves in the capacity of the Director PB Billing & Collections and Director-Customer Service during the absences of those positions.

• Other duties as assigned.