Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 45 hospitals and has more than 300 outpatient locations in 14 states providing more than 2.6 million patient visits annually. It is one of the nation’s leading health systems with nearly 50,000 employees and physicians. Fourteen of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

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The Corporate Director PFS Outsourcing and Strategic Initiatives is responsible for the implementation and management of the Strategic Right-sourcing Program, actively owning the operating portfolio under the Outsourcing program across Revenue Cycle Management for all Prime Healthcare. The Corporate Director is responsible for managing risk, value, and performance of outsourcing vendor relationships as well as developing and implementing PFS improvement initiatives to maximize value for the organization. The candidate will align and supplement existing Vendor Management policies and practices. The role requires the director to be able to manage multiple programs and projects and action items concurrently to drive performance across the enterprise. The Director may be responsible for analyzing end-to-end revenue cycle, and knowledgeable around the following:

• Patient Access: including preregistration, insurance verification, point-of-service collections, financial counseling, registration, self-pay to Medicaid and other programs approval and conversion
• Billing/Collections: analyze, through large datasets, unusual billing/collection trends and identify opportunities for process improvement and reimbursement optimization.
• Complex Claims Management: identifies, trends, and owns portfolios of complex claims, including Third party claims, TDRG, Zero Balance, and assists in the remediation of denial trends, including coordination with other departments as required.
• Patient Liability Collections: including programs to drive up patient liability collections – Early out, Bad Debt, primary, secondary and tertiary placements as needed, Drive Digital transformation and patient education and payment behavior

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EDUCATION, EXPERIENCE, TRAINING

Required Qualifications

1. Bachelor's degree (B.A./B.S.); a minimum of 8-10 years related experience and/or training; or equivalent combination of education and experience.
2. Five (5) years of experience with acute hospital/ facility revenue cycle setting.
3. Working knowledge of the Revenue Cycle spectrum: Patient Access, Coding, DNFB, Billing, Collections
4. In-depth working knowledge and experience with EPIC and Clearing houses (preferably)
5. Prior experience creating and implementing enterprise controls and oversight for outsourcing vendor relationships.
6. Ability to review and negotiate vendor agreements and scopes of work to ensure alignment with business needs and strategy.
7. Strong communication and relationship management skills.
8. Ability to form collaborative working relationships.
9. Strong analytical and problem solving skills. Ability to review weekly, monthly metrics – leading and lagging KPIs and own action plans
10. Ability to envision and execute; process and policy changes, change in corporate culture, alignment between enterprise strategy and individual business channel needs.

Preferred qualifications:

1. EPIC: basic navigation of systems as a minimum
2. Experience with Change Healthcare products (Relay Assurance)
3. Ability to work with large data sets, extremely comfortable with Excel and its functions (basic and advanced)
4. Proficiency in excel, powerpoint and other Microsoft products
5. Working knowledge of SQL and ability to run basic functions