Under the general direction of the Senior Director, Revenue of Cycle Operations, Hospital Billing and Professional Billing and the Senior Manager of Vendor Management, the Senior Revenue Cycle Business Partner (SBO) is responsible for assisting with hospital and professional insurance denials in coordination with revenue cycle, compliance, clinical team members, finance, and others as appropriate. Assists in the review and analysis of system issues and resolves issues with various vendors to improve effectiveness. The SRCA aides with development of departmental policy and coordinates team resources and activities to ensure both HB and PB Revenue cycle meets department goals and KPI’s. The Senior Revenue Cycle Business Partner scrutinizes and creates reports to identify trend and process gaps; identifies and resolves problems for maximum revenue and reimbursement to Boston Medical Center. Assist with implementation and testing of new EPIC WQ’s, system enhancements to optimize processes. Within the appropriate scope of responsibility and span of control, this position also works with various departments, BMC vendor partners and payers to develop the appropriate processes, monitoring controls and reporting to optimize operations. The SRCBP grounds all department activities to help BMC meet its core purpose: Exceptional Care, without exception. Furthermore, the SRCBP supports and exhibits BMC’s three core values: built on respect and empowered by empathy; moves mountains; and many faces create our greatness.
Position: Senior Revenue Cycle Business Partner
Department: PFS Administration
Schedule: Full Time, Quincy MA
ESSENTIAL RESPONSIBILITIES / DUTIES:
General management responsibilities:
Aides with coordination of the HB and PB vendor liaison teams activities to achieve departmental goals for increasing cash collection by lowering insurance denials and patient account receivables.
Interacts with BMC departments and outside vendors and payer representatives to address account resolution barriers.
Documents processes among important internal customers (including but not limited to, Case Management, Patient Access, Registration, Coding, outside vendors), identifies gaps, and recommends changes in policies, processes and procedures to address operational needs and to ensure continuous quality improvement.
Review, monitor, and report on issues identified in Epic dashboards, focusing on claim edits and open account receivable balances.
Performs work queue review to ensure accounts are worked timely and accurately within service level agreements.
Consistently monitors federal, state, and third-party payer regulations and guidelines and conveys updates to all department customers.
Cultivates, maintains, and enhances relationships with third party payers
Demonstrates problem-solving solutions and initiates changes as required.
Develops, monitors, and uses reporting tools, monthly reports, and root cause analyses for denial management and outstanding accounts receivables.
Communicate all denial trends and denial increases to Senior Director and Director in order to positively affect the volume of denials.
Work with ancillary departments’ staff and third party payer provider representatives to identify source of denials and develop processes to eliminate and / or minimize denials and rejections and improve cash flow.
Maintains clear channels of communication for effective problem-solving, as related to denials and write-offs.
Depending on departmental needs the work may shift and the position will need to be able to prioritize and work on multiple assignments.
Assists in the training of employees within the Revenue Integrity denials department.
The Senior Revenue Cycle Business Partner performs all these functions in a manner that complies with standards established by Hospital Administration, Medical Staff, and outside regulatory and accreditation agencies.
Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization
Preform other duties as required
Systems, analysis and reporting
Analyzes data and produces reports to identify areas of focus, account resolution, and the overall effectiveness and efficiency of the unit.
Collects accurate and timely information and creates reports that highlight activity trends.
Analyzes trends and interprets results.
Identifies, reports, and resolves issues relating to all revenue cycle IT platforms (including but not limited to Epic, FINThrive, Medicare FISS, Trizetto, and HealthRise).
Reviews operations and uses data to determine overall performance, team performance, error rates, system disconnects, etc.
Prepares ad hoc and standard reports to communicate interpretational analysis.
Recommends solutions to problems using existing resources in compliance with budgetary constraints.
Professional use of self and personal development
Consistently demonstrates tact, courtesy and a positive attitude in communication and interaction with all internal and external customers.
Collaborates to resolve issues and concerns relative to service quality, systems, and other identified problems.
Represents the department at meetings and on committees.
Participates in the decision and policy-making process on hospital-wide issues, particularly those which relate to Revenue Cycle activities, as assigned.
Represents the department and the hospital in a positive manner.
Demonstrates professional and focused, written and verbal communication at all times and in all interactions.
Demonstrates and models the AIDET framework in appropriate context and interactions.
Responsible for professional development to ensure appropriate knowledge of systems and advances in the administration of billing and collection activities.
Attends seminars and reads reports and publications issued by regulatory agencies, third-party payers, etc., to maintain and display appropriate knowledge of developments to the regulatory environment and billing and collecting activities.
Identifies personal and professional areas for improvement and actively seeks out ways to meet developmental needs.
Uses hospital's Core Purposes and Values as the basis for decision making and to facilitate PFS’s contribution to BMC’s mission. IND123
Must adhere to all of BMC’s RESPECT behavioral standards.
(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required). IND123
JOB REQUIREMENTS
EDUCATION:
Bachelor’s degree in Business/Healthcare related field preferred or equivalent combination of formal education and work experience.
EXPERIENCE:
Minimum of five years of experience related to healthcare finance, and Revenue Cycle management required, preferably in an Academic Medical Center setting.
Requires an extensive knowledge of policies, procedures, systems and equipment relating to revenue cycle operations; of regulations and guidelines pertaining to third-party payers and self-pay patient
Requires the ability to develop policies, procedures, processes and programs; to analyze data and interpret statistics; to create a variety of narrative, statistical, and reports, including trend analysis; to identify and resolve problems; and to interpret guidelines and regulations
KNOWLEDGE AND SKILLS:
Work requires interpersonal skills necessary in team building endeavors; to collaborate with other departments in support of the hospital goals and objectives; to establish and maintain effective, cooperative working relationships with all BMC employees to act as a liaison to third-party representatives and represent the hospital’s interests while negotiating and obtaining contracts; and to train employees.
Ability to work independently and possess effective time management skills to permit handling of multiple projects and or tasks
Proven advanced level abilities in problem management, process analysis, and root cause analysis
Interviewing/listening skills required to enable talking with individuals and groups about current processes and issues to ask the right questions to yield essential information that will be used to evaluate processes and determine potential solutions.
Ability to communicate analysis including trends and opportunities to stakeholders both verbally and through writing
At minimum, intermediate level of proficiency with Window based software, including but not limited to Microsoft Word, Outlook, Excel and PowerPoint
Excellent presentation skills and interacting with senior levels of hospital management and with physician leaders.
Excellent organizational and project management skills.
Highly responsive to manage time effectively, attention to detail, and follow through.
Strategic thinker with business acumen.
Superior analytical skills to evaluate information gathered from multiple sources and synthesize into actionable information
Excellent writing, interpersonal and organizational skills
Working knowledge of healthcare applications including, but not limited to Epic and nThrive.
Compensation Range:
$78,000.00- $113,000.00
This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.
NOTE This range is based on Boston-area data, and is subject to modification based on geographic location.
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Boston Medical Center (BMC) is a 511-bed, equity-led academic medical center and a proud member of the Boston Medical Center Health System. BMC delivers a model of healthcare where innovative and equitable care empowers all patients to thrive. As a premier academic medical center in Boston, a national leader in clinical care, and the largest essential hospital in New England, BMC’s world-class clinicians provide comprehensive care in more than 70 specialties and subspecialties.
BMC understands that health equity is foundational to community wellbeing, and it requires transformative thinking, rewriting policies that have historically underserved communities, creating access to cutting-edge care for all, and co-creating programs with community partners that serve as national models for improving patient outcomes and experiences. We are invested in going above and beyond what is traditionally considered medicine to meet the needs of our communities and address disparities in clinical care and beyond.
By pioneering cutting-edge research and advancing scientific discovery, we are fostering a culture of innovation where novel treatments and therapies are not only effective but also accessible.
Boston Medical Center Health System is an integrated academic healthcare system that models a new kind of excellence in healthcare where clinical and operational innovation meets health equity and access. With more than 15,000 dedicated employees, BMC Health System is committed to advancing scientific discovery and access to care, partnering with our communities, and developing scalable approaches to restore and maintain health.
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