Highland Health Providers Executive Director
Highland Health Providers Corporation
Department: Highland Health Providers Corporation
Reports to: Board of Directors
FLSA Code: Exempt
The Executive Director of Highland Health Providers Corporation reports directly to the Board of Directors and is responsible for the administrative and clinical management of Highland Health Providers Corporation. The Executive Director is responsible for administrative and clinical operations to ensure compliance with federal, state and local laws and regulations, and ensures office operational excellence, billing operational excellence and customer service excellence.
- Coordinates and supervises daily corporate operations, including clinical and administrative employee work activities and schedules, provider patient schedule efficiency and effectiveness of daily billing operations. Actively promotes teamwork for overall Center efficiency.
- Monitors effectiveness of overall billing operations, including individual office daily balancing and claim verification, credentialing and recredentialing, accounts receivable aging, days in AR, electronic claim reports, credit balance reports, collection agency reports, refund activity, productivity reports, and other reports necessary to effectively manage AR for Center
- Proactively reviews insurance carrier bulletins for new information to disseminate and train Center staff, so Center knowledge is always current.
- Ensures that all supplies are maintained responsibly and used efficiently.
- Effectively manages staffing levels and expenses by responding to the demands of the changing patient acuity and volume in a positive, efficient manner for all Center divisions/offices.
- Demonstrates responsibility and accountability for continuous improvement, and practices quality service as evidenced through quality results and patient satisfaction surveys.
- Demonstrates responsibility and accountability for enhancing positive relations with patients, families, co-workers, providers and administration.
- Conveys a positive and professional image of administration, providers, offices, and co-workers.
- Unit Specific Accountabilities:
- Maintains high ethical standards. Provides direction to administrative and clinical employees and outsourced billing vendor. Possesses a comprehensive and current knowledge of administrative and clinical office practice, and the application to quality patient care. Possesses good verbal and written communication skills. Shares knowledge with others. Displays a willingness to listen and be flexible. Respects the confidential nature of information concerning corporate matters.
- Consistently keeps contracted administrative and financial contractors informed of Center activity.
- Coordinates activities with other offices, outsourced billing vendor and contractors to ensure financial success of Center. Monitors and maintains daily audits to assure timely billing of daily services from all Center divisions/offices, as well as effectiveness of outsource billing vendor.
- Reviews daily work of all divisions/offices, ensuring that all divisions/offices have balanced charges, cash, checks, and credit cards for quality reporting to contracted accounting and outsourced billing vendor.
- Meets with contracted Accounting Controller monthly to review any discrepancies identified during monthly bank reconciliations.
- Reviews AR monthly, keeping abreast of current claim totals, and questioning outsourced billing vendor on larger balance individual accounts going from 60 days to 90 days, 90 day accounts with no activity, and 120 day accounts. Days in AR goal is to be 46 or less.
- Uses knowledge of PayerPath to question possible trends in denials, coding issues, etc., and discusses/proactively resolves with outsourced billing vendor.
- Collaborates with staff, outsourced billing vendor, insurance carriers, patients, etc. to proactively resolve billing issues.
- Maintains provider credentialing grid and credentialing information for Center. Collaborates with contracted administrative contact and outsourced billing vendor to make certain all new providers are credentialed efficiently, recredentialing is maintained with contracted carriers, and new insurance carriers are brought to the attention of appropriate individuals for review and consideration.
- Runs credit balance report monthly, to make certain outsourced billing vendor is processing credit balances in a timely manner.
- Conducts random sampling (at least 10%) of monthly refund report processed by outsourced billing vendor, acquiring appropriate EOBs and back-up from outsourced billing vendor to assure that refunds are being handled appropriately.
- Meets with outsourced billing vendor quarterly to review effectiveness of collection agency assigned to Center accounts.
- Runs regular reports to ensure effective and efficient billing operations; runs requested billing and administrative-type reports for contracted administrative and financial advisor; works collaboratively to facilitate contractual negotiations with insurance carriers.
- Functions as primary contact for reporting needs for contracted advisors, staff and providers for maximum Center efficiency.
- Demonstrates organization skill in office knowledge to make providers’ day more efficient through efficient and effective scheduling practices for Center providers. Goal is for providers to see a minimum of 3 patients per hour.
- Fosters in office staff a feeling of responsibility for the work assigned and satisfaction in the job and of being an important part of the Center team.
- Demonstrates effective leadership techniques as evidenced by high productivity and morale of employees and providers through consistently meeting objectives.
- Mentors and serves as a role model for staff through complying with Center policies and procedures, as well as 5-Star Customer Service Excellence and AIDET initiatives.
- Works collaboratively with administrative contractors by maintaining staff within approved budget for Center. Ensures the consistency of staff at each Center division/ office for maximum provider efficiency.
- Acts as liaison between physicians, staff, administration, patients, families, and outsourced billing vendor.
- Treats all customers with respect and responds in a timely and courteous manner to customer (providers, fellow employees, patients, families, visitors, billing staff) complaints.
- Demonstrates positive problem solving approach in resolving concerns or issues with staff, other departments, outsourced billing vendor or providers as indicated by positive responses of contacts.
- Demonstrates organizational skill in providing clinical and administrative services and consistently implements appropriate action to guide staff in meeting office needs.
- Manages assigned projects and prepares reports, accordingly.
- Possesses excellent competency in EHR problem-solving and use. Functions as SuperUser for Center EHR clinical and administrative processes.
- Processes all Center staff timecards per contracted guidelines. Approves all staff overtime, if necessary, in advance of staff performance of overtime hours.
- Honors patient rights to privacy and confidentiality, and provides direction to clinical staff in this regard. Demonstrates active knowledge of HIPAA, and performs annual HIPAA training of all Center staff.
- Demonstrates cultural competency and skill in meeting age-related, handicapped and minority patient needs.
- Demonstrates knowledge of Occupational Safety and Health Association (OSHA) guidelines and continuously observes office areas for safety violations.
- Works collaboratively to create, maintain and annually update Center policies and procedures per FQHC regulations. Administers policies in a consistent and timely manner.
- Actively participates in office audits through assuring compliance of policies, procedures and protocols of Center.
- Uses appropriate resources to develop knowledge base of staff through educational presentations, seminars and developing orientation procedures in correlation with other coordinators. Plans and conducts meetings and discussions with staff as appropriate.
- Follows protocol for replacing or adding staff. Conducts interviews for open positions, recommends appropriate personnel to staff needs as evidenced by a low turnover rate of Center employees.
- Trains personnel to assigned positions and responsibilities as evidenced by completion of training documentation, fulfillment of departmental responsibilities within the approved FTE budget and effective use of Allscripts. Trains staff to anticipate provider and patient needs. Trains staff to recognize and immediately report concerning patient conditions.
- Evaluates performance, recommends merit increases, and works with administrative contractor when need arises for counseling and disciplining administrative staff to ensure quality of work and adherence to Center policies and procedures, as well as compliance with all federal and state regulations.
- Participates in educational experiences that improve technical and managerial expertise as evidenced by meeting objectives and by attendance at related meetings and seminars. Attends regular meetings with contracted advisors.
- Keeps current in field by reviewing relevant literature, attending workshops and seminars and networking with colleagues as demonstrated by implementing advances in patient care.
- Actively and enthusiastically participates in the development of goals and projects for the Center. Works collaboratively contracted advisors to prepare and maintain an annual department budget and monitor expenditures within these guidelines.
- Complies with all aspects of Center employee health protocol. Reports work related injuries and illnesses at the time of occurrence and follows Center policy regarding extraordinary health situations (HIV exposure, TB exposure, needle stick.)The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills of personnel so classified.
Education – Required: Bachelor’s Degree in healthcare related field or business
Education – Preferred: Master’s degree in health or business administration
Minimum Experience: Minimum of 5 years healthcare experience
Preferred Experience: 8 years previous experience including 3 years management level experience in medical practice management
Competencies Required: New business/service line development skills, demonstrated success in budgeting, financial analysis and reimbursement, excellent interpersonal and communication skills, strategic forecasting, information systems expertise, demonstrated success in operational redesign. Current valid driver’s license and reliable transportation
Supervises: Medical Director, Clinic Manager, Office Leads, Billing Specialist, Medical Assistants, Receptionists
Physical Demands: Should be physically and emotionally able to handle irregular hours with minimal absences. Must have ability to handle multiple tasks simultaneously while dealing with distractions. Must be able to effectively prioritize. Must be able to emotionally handle stress of demanding position with grace and professionalism. Prolonged, extensive, or considerable standing/walking/sitting. Must have sufficient hearing and vision to carry out the administrative process.
The position requires the successful completion of a medical examination after offer of hire has been made. The position requires the employee to be free of all unlawful substances and alcohol.
Work Environment: Office environment. Occasional unpleasant and/or stressful work-related situations. Leader in emergency crisis situations.
Work Schedule: 80 hours in a 2-week pay period. Must be willing to work occasional irregular hours according to HHP needs.