This position is responsible for providing leadership and oversight of operational and financial decisions and performance pertaining to Claims, Payment and Credit for SSM's Physician and Ambulatory Services Organization. The System Director will manage operational claims, payment and credit leaders across three business offices serving six SSM regions. Functional areas under the System Director, Claims, Payment, and Credit include: the claim edit and submission processes, payment posting, cash reconciliation and management, and credit balance resolution.
The incumbent serves as the leader of the Claims, Payment, and Credit function for the SSM Physician Revenue Organization. He/she serves as the primary contact for Claims, Payment, and Credit to internal and external organizations, including clearinghouse vendors, banking and credit card processing partners, SSM's Integrated Health Technology (IHT) management and staff, and SSM Finance management and staff. The incumbent is expected to ensure that the PRO is optimizing the electronic claims and remittance processes through the use of Epic, direct connections to payers, and clearinghouse vendors. He/she will provide strategic vision to Claims, Payment, and Credit operations across the SSM Physician and Ambulatory Service Organization and challenge assumptions and standards of business in an effort to improve overall operational effectiveness and service to SSM's customers.
Provides system-level strategic direction for the Claims, Payment, and Credit Department. Develop a high-functioning, best practice claims, payment and credit team to ensure full revenue capture and efficient operational performance.
Set strategy/approach regarding claims, payment posting, cash reconciliation and credit balance processing functions. Develop department goals, objectives and tactical plans consistent with the organizational strategic plan and vision. Ensure comprehensive policies and procedures, desk level procedures, and other work tools are developed and available to all department staff to facilitate training and work accuracy.
Develops objective quality and productivity measures for staff and, in conjunction with department managers and supervisors, actively monitor these to ensure high quality, productive performance. Ensure deficiencies are addressed timely.
Identifies staff needs and removes barriers to ensure staff are able to meet the quality, productivity, and performance expectations set for them. Ensure training programs are sufficient to support staff and facilitate effective performance.
Creates a work environment for staff through team building, coaching, constructive feedback, work delegation, personal example and goal setting that encourages creativity, open dialogue on work issues, professional growth, and a consistent, high level of performance. Encourage and support staff decision-making within their scope of responsibilities.
Anticipates external and internal factors that require operational, system or personnel changes within assigned areas. Actively and continuously monitor key performance metrics, analyze workflows, organizational structure, staffing assignments or other factors to ensure optimal performance; make recommendations and modifications, as necessary.
Evaluates Epic system build to ensure comprehensive claim edits are implemented, or recommend ancillary systems/tools, if appropriate, to ensure optimal claim scrubbing/clean claims submission.
Ensures, through collaborative work with payers, clearinghouse vendor, Epic, and SSM IHT, maximization of electronic claims submission (835), remittance posting (837) and funds transfer (EFT). Work with same to gain adoption of electronic claims attachment functionality.
Ensures consistent, accurate daily cash reconciliation in coordination with SSM PBS and SSM Finance.
Manages bank accounts and credit card processing accounts with SSM Treasury department, streamlining the number of accounts, where feasible, and ensuring optimal service and market-competitive banking fees.
Conducts denial root cause analysis with team to identify opportunities for error reduction, including additional system edits, provider education, clinic management feedback, etc.
Maintains an understanding of governmental regulatory changes within the industry, local markets, etc. that may require updates, modifications, or changes to the claims, payment, or credit policies, procedures, set-up, or processes to ensure compliance with these regulations.
Works with system office and regional colleagues throughout SSM to continuously improve the PRO, while enhancing service to patients, and optimizing relationships with strategic business partners.
Builds strong relationships and facilitate productive communication between key PRO stakeholders, including peer leaders of PRO and core support departments (e.g., human resources, integrated health technologies, finance).
Develops and monitors budget for the Claims, Payment, and Credit department.
Recognizes departmental areas of excellence and oversee the development and implement action plans where performance is not meeting expectations.
Performs any special assignments, as requested.
Qualifications Minimum Requirements:
Bachelor's Degree in business or related field
A minimum of seven years of increasingly responsible experience in health care finance or IT, of which includes a minimum of five years in professional billing and a minimum of three years in a Director level role.
In depth knowledge of professional billing software
In depth knowledge of and experience with electronic claims submission (HIPAA 835 transaction) and remittance posting (HIPAA 837 transaction) and funds transfer (EFT).
Master's degree preferred
Knowledge of Epic preferred
SSM Health - System Office –
SSM Health is one of the largest Catholic health systems in the country and is dedicated to quality and compassionate care for anyone in need, regardless of ability to pay. Based in St. Louis, where its System Office is located, SSM Health operates 20 hospitals in Wisconsin, Illinois, Missouri and Oklahoma. We provide care in various settings: outpatient sites, physician offices, a pharmacy benefit company, an insurance plan, hospitals, nursing homes, home care, hospice, telehealth and a technology company.Our Mission: Through our exceptional health care services, we reveal the healing presence of God.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same