Position Summary: Responsible for planning, directing and overseeing all aspects of assigned Patient Financial Services units, including, but not limited to, non-governmental and government denials, including commercial, managed care, government managed care, ERISA plans and all others. Ensures standards of unit operations are in compliance with all state and federal healthcare regulatory agencies. Incumbent has overall responsibility for training, unit performance, resolution of operational and personnel issues, evaluations, hiring, and disciplinary action. Participates on organizational performance improvement projects. Analyze Denial trends and publish organizational reports to improve first pass yield. Serves as a role model and resource to colleagues, staff, and others. Interacts with all levels within the organization, including senior leaders, managers, directors as well as insurance companies, third party payers, vendors and regulatory agencies.
Required Qualifications:Ability to maintain a work pace appropriate to the workloadAbility to motivate staff to achieve desired resultsBachelor's Degree in related fieldDemonstrated experience building competency and developing skills of othersDetailed understanding of billing technical elements such as standard forms and data elements, coordination of benefit and third party liability billing and collection, electronic billing, data edit programs, reimbursement methodologies such as Diagnosis Related Groups (DRGs), Case Rate, Percent of Charges, capitation.Excellent written and verbal communication skills in EnglishExtensive knowledge of governmental compliance rules and issues as it pertains to health care billing, collection and other reimbursement.Minimum 5 years in a leadership/managerial position in a revenue based, health care related industry such as admissions, registration, billing/payor or contracting.Minimum 5-10 years' experience in hospital patient account services.Must have experience in working with contracts, applying terms and conditions to claims and performing split billing as required by Contracted Payers and DOFRs.Must possess the skill, knowledge and ability essential to the successful performance of assigned dutiesSelf- directed and organized with superior analytical and problem-solving skills.Sound understanding of Joint Commission and other applicable regulatory requirements to be able to monitor for complianceThorough knowledge of healthcare billing, finance and compliance and strong understanding of facility billing systems.Working knowledge of billing commercial claims, workers compensation, managed care and all other third party payers.Working knowledge of billing, follow up and denial management of commercial claims, workers compensation, managed care and all other third party payers.
Preferred Qualifications: Experience in PFS Operations, University and medical center organizations, policies, procedures and formsKnowledge of University and medical center organizations, policies, procedures and formsMaster's degree in Health Care Management, Business, Finance or AccountingPrior management experience of union-represented staff
Physical, Mental & Environmental Demands:To comply with the Rehabilitation Act of 1973 the essential physical, mental and environmental requirements for this job are listed below. These are requirements normally expected to perform regular job duties. Incumbent must be able to successfully perform all of the functions of the job with or without reasonable accommodation.
Since 1965, the University of California, Irvine has combined the strengths of a major research university with the bounty of an incomparable Southern California location. UCI's unyielding commitment to rigorous academics, cutting-edge research, and leadership and character development makes the campus a driving force for innovation and discovery that serves our local, national and global communities.