SUMMARY:

Evaluates and monitors the clinical revenue-generating operations and systems of the clinical programs. Develops and assists in the implementation of business strategies, policies, protocols, and systems that improve practice productivity, efficiency and customer service, and that support the enhancement of revenue. Supervises the day to day operations of the following departments: Billing, Front Desk Operations, Adult and Child Access Centers.

ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may be assigned.

Plans, monitors, and quality-controls the performance of the clinical revenue-generating operations of the program; develops and implements appropriate operating benchmarks and standards.

Assists managers in identifying and using management reports; gathers clinical practice data from a wide variety of internal and external sources.

Participates in strategic business planning for the department; researches new clinical practice opportunities, and makes recommendations to management regarding financial feasibility.

Develops, implements, and evaluates the department’s annual clinical revenue action plan with the program directors and senior management.

Monitors and evaluates the provision of client services within the program, to include all operations affecting billing and provider productivity; interacts with and guides clinical managers in the enhancement of operating efficiency and improvement of responsiveness to patients.

In conjunction with program and finance staff coordinates the billing processes and systems of the program; assists in identifying trends of billing, authorization and coding problems and provides feedback to managers and clinical staff.

Prepares and distributes periodic and ad hoc reports on practice and compliance issues and performance indicators.

Performs miscellaneous job-related duties as assigned.

OCCASIONAL DUTIES: Serve on appropriate Providence Center committees.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE:

Bachelor's degree; at least 5 years of medical/behavioral health practice management experience.

LANGUAGE SKILLS:

Ability to read, analyze, and interpret documents, professional periodicals and journals, and technical procedures or regulations. Ability to write reports, correspondence, and to develop procedures. Ability to effectively communicate, presenting information and responding to questions from Center staff at all levels and to conduct staff trainings. Must also represent The Center effectively at outside meetings.

REASONING ABILITY:

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to analyze and interpret an extensive variety of clinical data and deal with several abstract and concrete variables.

CERTIFICATES, LICENSES, REGISTRATIONS:

Must have valid driver's license and insured auto.

OTHER SKILLS AND ABILITIES:

Ability to communicate and interact effectively with practicing physicians and clinical management.

Knowledge of current legislation and developing legal issues and trends in medical billing, coding, and associated documentation.

Working knowledge and strategic understanding of medical billing and reimbursement principles, procedures, and documentation.

Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures.

Ability to analyze and interpret financial and operational data and prepare business reports, projections, and recommendations.

Advanced knowledge and understanding of the business and operating characteristics of a large, complex behavioral health practice.

Ability to develop, prepare, and implement business plans and resource/revenue generating strategies.

Knowledge and understanding of the clinical contracting process for managed care, government, and private sector agencies.

Skill in the analysis and evaluation of clinical billing operations and provider productivity.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to handle, or feel objects, or controls; and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk.

WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Care New England Health System (CNE) and its member institutions; Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.