The Director of Transplant Revenue Cycle is responsible for the financial operations and business services for all transplant related programs and services, including oversight responsibilities for compliance with regulatory, accrediting, and third party payer regulations and standards. Oversees the timely, seamless, and accurate financial clearance for all inpatient and outpatient transplant related services and directly manages challenging cases. Partners with the Vice President, Transplant Services and others relevant parties across the system to provide oversight for the transplant patient revenue cycle including management of patient accounts to align with payor requirements. Collaborates with the Managed Care department to ensure the sharing of insurance plan updates, coordination of coverage, and negotiation of single case agreements. Assists with the Medicare Cost reporting process and time studies. Oversees accounts payable for donor acquisitions and searches, NMDP, DNAZ and other outside providers. Directly supervises the Transplant Financial Coordinators, Patient Account Representatives, Transplant Reimbursement Specialists, and fosters a team dynamic of excellence and service. Maintains knowledge of all relevant systems including OTTR, SCM, UNOS and ensures the competency of the Transplant Financial Coordinators and Patient Account Representatives.
- Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
- Excellence in clinical care, service and communication
- Collaborative within our institution and with others who share our mission and goals
- Leadership that set the standard for pediatric health care today and innovations of the future
- Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Manages operational activities.
- Manages daily operational activities and support staff ensuring work flow processes are consistent within all applicable regulations, policies, procedural guideline and best practices for transplant revenue cycle operations. Directs, manages, and evaluates effectiveness and efficiency of authorizations, financial counseling, billing, collections, and cash posting for transplant services.
Maintains transplant database.
- Ensures OTTR and the transplant database are adequately updated and/or maintained. Prepares and distributes reports as needed to monitor key metrics.
Maintains vendor relationships.
- Establishes and maintains vendor relationships for purchased services by maintaining prompt and accurate payment for services rendered. Collaborates with contracting, compliance and legal in developing operational language to support purchased service agreements.
Collaborates with all necessary departments to maintain compliance.
- Works collaboratively with the Vice President, Transplant Services and numerous stakeholders to ensure transplant program remains financially viable and compliant with state and federal laws and regulations. This includes managed care contracting, finance, providers and clinical staff. Serves as point of contact for the Transplant Cost Report.
Develops operating budget.
- Responsible for the development of an annual operating budget for assigned areas that encompasses both current and future operational demands. Leads the fiscal oversight of allocated resources in order to optimize efficient and effective utilization of resources.
Monitors Quality Assurance.
- Monitors QA results and identifies opportunities by partnering with the training coordinator to implement solutions.
Staff supervision and development.
- Develops and supervises staff through provision of timely feedback and use of appropriate Human Resource policies and tools to facilitate and ensure the ability of staff to achieve highest level of professional growth and desired performance standards. This includes hiring and performance management of staff. Generates enthusiasm and commitment among team members to foster and reinforce team performance.
- Performs miscellaneous job related duties as requested.