Senior Director Hospital Billing and Coding

Department Overview

The Senior Director of Hospital Billing and Outpatient Coding is responsible for strategic activities as it relates to the mid-cycle and back-end patient-related revenue cycle activities for OHSU Health which includes OHSU and all of OHSU system partners both current and future.

• The operational functions under this position's oversight include direction over diagnosis coding and abstracting all outpatient facility accounts, inputting charges, combined customer service, billing to all third parties, follow up with those third parties to ensure payments are received in a timely manner, denial management, payment review, cash posting and credit balance analysis and resolution, referral to bad debt and the overall operational effectiveness of Hospital Billing and Coding. This position will focus on revenue cycle operational performance excellence across the system and improving the patient experience with a focus on cost containment.
• The Senior Director oversees and is responsible for the Epic systems build including claims maintenance and the development of Epic and operational revenue cycle workflows.
• The Senior Director oversees and is responsible for the Huron system and partnerships as related to the back-end revenue cycle.
• The Senior Director will respond proactively to maximize revenue opportunities related to revenue cycle through third party partners and through automation of more efficient workflows. Responsibilities will include creating the best practices in each of the revenue cycle areas above that can be shared and implemented across the system affiliates.
• Critical responsibilities include the achievement of annual and periodic goals for significant statistical indicators of revenue cycle performance that contribute to the financial performance of OHSU and OHSU Health partners.
• The Senior Director will work collaboratively with internal partners in Hospital Financial Services, HIS, Care Management, clinical and ancillary departments and senior leadership to assure compliance with hospital coding, billing and reimbursement.
• This position reports to the Vice President of Enterprise Revenue Cycle for OHSU Health and has oversite responsibility for the staff and duties related to the functions described above, as well as directing strategic initiatives and enterprise wide performance improvement initiatives, to ensure smooth revenue cycle operations that meet the patient care and financial needs of OHSU and OHSU Health partners in a way that demonstrates compassion and service to our patients and their families.

Function/Duties of Position

• Leads and directs the Hospital Billing and Coding Revenue Cycle team. Works with leadership across the system to carry out comprehensive, integrated planning for all areas of responsibility with emphasis on strategic initiatives, patient centered processes and continual process improvement. 

  • Develop strategic plans that are compatible with the OHSU Health's mission, goals and objectives.

  • Establish and coordinate procedures for timely coding, billing, posting and collection of accounts to assure positive cash flow and effective management of credit balances. Provide administrative directions to the management staff.

  • Establish expectations and plans, set priorities, and manage processes to measure, assess, and implement improvements to services provided. Measure, monitor and report progress towards quality goals on a routine basis. 

  • Synthesize qualitative and quantitative information and identify trends to keep the cash flow on course. 

  • Monitor un-billed reports and work with departments (PAS, ITG, and Care Management) to resolve issues in a timely manner so not to delay billing functions. 

  • Communicate with third party payors in regard to claim processing difficulties or new processing procedures. 

  • Participate in OHSU and OHSU Health partners system wide front end, mid-cycle and back-end revenue cycle, denial management and access management work teams. 

  • Maintain a working knowledge of applicable National, State, and local laws and regulations, the hospital Compliance Program, Code of Ethics as well as other policies and procedures. 

  • Participate in Revenue Cycle projects as directed by Vice President of Enterprise Revenue Cycle. 

  • Assist Revenue Cycle Team in staffing, managing, documenting, and completing assigned projects. 

  • Ensure all assigned department performance appraisals are completed on time.

• Responsible for appropriate staffing of OHSU Health Hospital Billing and Coding positions, performance evaluations and recommendation for promotions, counseling and disciplinary action. Demonstrate ability to initiate planned change in departmen