Description: Department Overview: Operational Effectiveness The Operational Effectiveness team supports both the Physician Practice Groups (PPG) and PB Operations, driving performance through strategic process improvement and revenue cycle (RC) management. Role-Specific Responsibilities:Physician Practice Groups (PPG) Front-End RC Management
- Train front-end staff on registration workflows, insurance eligibility, and pre-authorization protocols
- Educate users on resolving claim edit errors and interpreting real-time eligibility responses
- Conduct monthly KPI report-outs tailored to assigned specialties, focusing on registration, eligibility, and denial trends
- Identify and address front-end process gaps to enhance revenue cycle performance
PB Operations Back-End RC Management
- Lead initiatives to improve operational efficiencies through structured process improvement methodologies
- Track and analyze issues and opportunities across the revenue cycle
- Gather detailed data and stakeholder input to support targeted improvement efforts
- Facilitate cross-functional collaboration to implement sustainable solutions
RESPONSIBLE FOR: Responsible for facilitating or supporting Revenue Cycle Operational Effectiveness and performance improvement initiatives in collaboration with operations without direct supervisory responsibility over team members. Responsible for scoping projects, developing project plans and assisting with implementing solutions. This also includes, initiating, executing and managing Revenue Cycle Operational Effectiveness initiatives, research, and related projects. Serve as an internal consultant related to Revenue Cycle. Work will span the course of operational and financial areas and will be determined based on areas in need of process improvement, improved results, project management and/or oversight such as development of processes, work flow analysis, strategic planning and business plan development as well as other areas requiring attention. He/she performs operational research and root-cause investigations based on stakeholder requests; collaborates with operational stakeholders in the development and design of operational changes that will create revenue opportunities and drive best in class patient experiences; and ensures proper cataloging and use of industry best practices and benchmarks. Qualifications:
MINIMUM EDUCATION REQUIRED: Bachelor's degree in Business Administration, Healthcare Administration, or a related field is required. In lieu of degree, six (6) years of relevant work experience will be accepted in addition to the experience requirement.
MINIMUM EXPERIENCE REQUIRED: One (1) year of progressively responsible project management or process improvement experience. (If no degree, a total of seven (7) years of experience required).
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW: None.
ADDITIONAL QUALIFICATIONS: Master's degree preferred. Understanding of revenue cycle operations and technology; Certification in Lean, Six Sigma or similar improvement methodologies strongly preferred. Excellent written and verbal communication skills including the ability to present ideas in a clear and compelling manner to both executive and staff level audiences. Previous experience using or implementing Epic is desired.
