The Hospital CRO/CFO is both accountable and responsible for all aspects of the revenue cycle and the hospital financial management for the assigned hospital(s). The position reports to the Regional Chief Revenue Officer/ Chief Financial Officer with an additional reporting relationship to the assigned local Hospital(s) President.

KEY RESPONSIBILITIES:

The hospital CRO/CFO is accountable for ensuring all aspects of a fully optimized revenue cycle operation within the hospital setting including an advisory role to ensure financial statements are accurate and explained. The role is accountable for meeting Steward “Key Financial Metrics,” and working to appropriately address metric variances.

Accountable for overall revenue cycle, revenue integrity/quality, and ensuring all billing compliance and government regulations are followed.

Accountable for appropriate and accurate daily charge capture by department, daily department revenue reconciliations, fixing rejected charges, and minimizing late charges.

Accountable for oversight of denial management including edit work lists, root cause analysis, recommendations for process/system enhancements, and overall coaching and leading staff.

To advise and collaborate with centralized financial reporting explaining variances and determine mitigating actions.

The role oversees and is responsible for leading internal hospital departments and ensuring staffing levels are optimized across revenue cycle and may include Patient Access (Registration, Patient Financial Services, Referrals and Authorizations), Care Management (CM), Health Information Services (HIM) and Coding, Clinical Documentation Excellence (CDE), Revenue Integrity (RI) and Charging, Payer Auditing, Local Finance, and other areas as assigned.

Accountable for the following revenue cycle and financial components (subject to change by area):

Patient Access. Responsible for the following:

Patient Registration.

Insurance verification and approvals.

Ensuring appropriate Referrals.

Ensuring accurate Authorizations.

Copay collections.

Working related edits and denials.

Care Management. Responsible for the following:

Concurrent case management duties.

Discharge services.

Responsible for working with third party payers with respect to all level-of-care and length-of-stay issues.

Denial Management and follow up.

Working related edits and denials.

Health Information Management and Coding. Responsible for the following:

All medical records, transcription and coding.

Monitoring and enforcement of completion of records by physicians.

Monitoring and enforcement of coding by clinical departments.

Oversee coding operations.

Working related edits and denials.

Clinical Documentation Excellence. Responsible for the following:

Accuracy and thoroughness of all clinical documentation.

Appropriate diagnoses and CPT/HCPCS billing categories applied.

Education and training of clinical teams.

Working related edits and denials.

Revenue Cycle Operations/ Revenue Integrity and Charging. Responsible for the following:

Responsible for daily charge review for tracking hospital performance

Ensure daily charge reconciliation by department.

Escalation and issue management

Charge master coordination with central office

Late charge variances

Steward Financial Metrics

Working related edits and denials.

Payer Auditing. Responsible for the following:

Responsible for defending the hospitals’ interests on all third-party payer audits.

Tracking and reporting payer audit issues.

Working related edits and denials.

Financial Responsibilities. Responsible for the following:

Review annual net revenue budgets for hospital(s). Explain variances.

Review accuracy of financial statements and balance sheets.

Review and explain all deductions from revenue and bad debt.

Review integrity of net revenue monthly for all hospitals.

Adhoc financial analysis as required.

All other duties and responsibilities as assigned from time to time, including additional areas of oversight depending on hospital needs.

Additional Information

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

Education: Bachelor's degree in relevant filed required, Master’s preferred.
Experience (Type & Length): Minimum of five - ten years’ experience in healthcare, with significant experience in hospital revenue cycle functions.
Hardware/Software: Meditech, MS Office (Excel, Word, PPT), Access, SQL, and/or other query/analytic tools.

North Shore Medical Center

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