Position Description: Director Professional Service Operations – Stanford Hospital & Clinics/Lucile Packard Children’s Hospital

Our highly prestigious client, Stanford Hospital & Clinics (SHC) is known worldwide for advanced patient care, particularly for the treatment of rare, complex disorders in areas such as cardiac care, cancer treatment, neurology, neurosurgery and organ transplants.  Stanford Hospital includes 611 licensed beds.  The clinics offer care in more than 100 specialties, including cancer, neurology, surgery and organ transplantation. 

Patients come to Stanford from all over the Western United States and the world, often for specialized procedures unavailable elsewhere.  In recognition of excellent care, the hospital and physicians consistently rank among the top in the nation in surveys by consumers and health care professionals. In July, 2002, Stanford was named to the Honor Roll of America's Best Hospitals by U.S. News & World Report.  The Hospital was ranked #14 out of 100, in 2004.

Founded in 1991, Lucile Packard Children’s Hospital (LPCH) is a 256-bed non-profit hospital devoted entirely to the care of babies, children, adolescents and expectant mothers.  The state-of-the-art, main facility is located on the Stanford University campus.  LPCH is affiliated with the Stanford University Medical Center and many of its doctors also serve as professors at the Stanford University School of Medicine.

Management

An overview of top management of the hospital shows an exceptional blend of clinical, operational and business expertise in the field of acute and specialty care and services.  Underlying the management team's skill-set is a passionate, deep-seeded and visionary commitment to excellence, innovation and growth.  The style of management and the organizational culture of excellence are deeply rooted in teamwork and mutual support. 

The level of teamwork and support among the management staff is extraordinarily high and remarkably effective.  This group of Managers and Directors, with their collaborative style and complete commitment to the mission, is the heart of the department’s success.  It is readily apparent that the management team consistently emphasizes teamwork, individual achievement and making the job fun.

To complement the management team, an individual must be able to blend their individual success into that of the entire team and share in the commitment and the satisfaction of taking care of the healthcare needs of the community.

Position Description

The Director Professional Service Operations will act on behalf of Stanford Hospital & Clinics (SHC) and it’s affiliates/customers in a variety of Professional revenue cycle related business matters with hospitals, insurers, health maintenance organizations, other health care providers, government bodies, attorneys and others as required.  This individual will direct and review the administration of all PSO revenue cycle operation policies and procedures consistent with SHC & LPCH objectives, coordinate these activities with SOM (School of Medicine) clinical departments, SHC administration and LPCH administration.  The position oversees 130 FTE’s and it serves approximately 800 doctors.  The system used in the department is IDX.

Reporting Relationships

Directly reports to the Vice President, Financial Operations – Stanford Hospital & Clinics with a matrix reporting relationship to the Vice President, Ambulatory Care.

Essential Functions and Responsibilities

The Director Professional Service Operations (PSO) has primary responsibility for Physician and other Allied Health Practitioner/professional, clinical revenue cycle activities at Stanford Hospital & Clinics (SHC) and Lucile Packard Childrens Hospital (LPCH).  Activities this position has direct responsibility for include Patient Billing, Insurance Billing, Governmental program billing, Contract billing, Payment application, Customer Service/Patient Relations, Collections and Clinical Department Relations/Revenue Management.

Activities such as Registration, Authorization/Referral Coordination, Charge Capture and Professional fee coding are accountable to this position as they relate to the revenue cycle.  This accountability is established with pre-defined standards and measurement tools.  In addition this position is expected to have a key role in Compliance, Contracting Strategy and Physician Business Operations/Strategic Planning.  The Professional billings from which revenue is generated is critical to Stanford Hospitals & Clinics (SHC), Lucille Packard Children’s Hospital & Clinics (LPCH) and Stanford University School of Medicine Clinical Departments (SOM).  Additional Responsibilities:

• Prepare annual objectives, plans of action and budgets for PSO
• Oversee development of effective lines of communication with SOM chairs, faculty and other members of SOM/SHC/LPCH administration regarding Professional revenue cycle activities.
• Participate in various SHC, LPCH and SOM standing and ad hoc committee’s and meetings, representing PSO.   Responsible for agenda development for the Professional Revenue Cycle Management Committee (PRCMC) with the committee Chair.  Chair of Professional Fee Billing and Compliance Sub-Committee (PFBCC) of the Committee on Management Controls and Compliance (CMCC).
• Participate in Professional Contracts Committee as a member and actively involved in pricing, contracting strategy decisions.  Ensure that payor contract performance is monitored, communicated appropriately and considered during contract negotiation.
• Ensure compliance with SHC/LPCH policies and SOM policies.
• Ensure adequate Data Control procedures are in place to support quality data information in both the A/R system and Data Warehouse used to support Professional business activities.
• Through subordinates, direct the following operations and activities:
  • Directs operation of third party billing.
  • Is responsible for development of policies and procedures that ensure the appropriate maintenance of PSO A/R systems.
  • Reviews and evaluates on a regular basis, the effectiveness of the third party billing, tracking and follow-up activities.
  • Oversee the coordination of the activities of third party billing with those of other departments within SHC, LPCH and SOM.
  • Oversee development and maintenance of good working relationship with third parties and government agencies receiving claims from PSO.
  • Ensures contracted payors are reimbursing or processing claims in accordance with the contract terms and escalating non-compliant issues when appropriate to Contracting and or Senior Executives to address.
  • Is responsible for insuring that the collected professional revenues are consistent with the terms of the contracts including appropriate coding for maximum reimbursement under the contracts.
• Directs operation of Cash Posting
  • Is responsible for development of policies and procedures that ensure accurate and timely recording of receipts in the A/R system and G/L.
  • Reviews and evaluates on a regular basis, the effectiveness of payment application activities.
  • Oversees the coordination and the activities of Cash Posting with those of other departments within SHC, LPCH and SOM
• Directs operation of Customer Service/ Self-Pay Collection
  • Is responsible to ensure that all telephone and mail inquires from patients are answered promptly and accurately.
  • Is responsible for development of policies and procedures that ensure effective collection of accounts receivable.
  • Reviews and evaluates reasons for patient inquiries on a regular basis and develops courses of action which will diminish patient confusion.
  • Reviews and evaluates on a regular basis, the effectiveness of collection activities.
  • Oversees the coordination of the activities of customer service and collection activities with those of other departments within SHC, LPCH and SOM.
  • Oversees development and evaluation of collection agency relationships with PSO.
• Directs and provides support to Professional Revenue Cycle management oversight
• Responsible for the identification, analysis, recommendation and communication of resolutions on issues from charge capture to account follow up as it relates to revenue enhancement and reimbursement.
• Serve as primary liaison between the SoM Clinical departments and PSO and assists in coordinating activates and conversations with other departments involved in revenue cycle issues (HIMS, SHC Clinic Admin, etc.).
• Monitors Health trends and developments
  • Directs the monitoring of appropriate journals and legislation, keeping appraised of rules and regulations affecting the PSO.
  • Recommends, in coordination with other pertinent SHC/LPCH/SOM departments responses to legislation or developments.
• Monitor through appropriate journals and personal contacts developments in the industry that may affect the effectiveness of PSO revenue cycle operations.
• Analyze legislation for impact on PSO billing practices, operations and reimbursement in conjunction with Office of Compliance and Government Relations.  Inform the CFO, Key Stakeholders, Clinical Departments and other appropriate committee’s about legislation likely to impact the PSO.  Participate in developing plans and responses to legislative changes.
• Performs other duties and special projects as required.

Qualifications

• An MBA and/or a minimum of ten years of senior management experience in health care administration, experience in a university medical center environment is highly desired.
• Must possess broad experience in health care financial management with an emphasis on physician accounts receivable management, preferably in a university setting.
• Must have a thorough understanding of government program regulations and requirements as they relate to patient accounting and billing.
• Must have a strong functional understanding of health care operations and physician group practices.
• MGMA (American College of Medical Practice Executives preferred.

Personal Characteristics

Director Professional Service Operations needs to possess the patience, self-confidence and communication skills necessary to work with the clinical and administrative staff and the Physicians.

First and foremost, this individual needs to be a team player, be a superb communicator and have the style of a diplomat, i.e., be able to work in harmony with other operational entities and to negotiate agreements so each party benefits. It is imperative that he/she be skilled in bringing together the staff functions in a spirit of harmony and with a single-minded purpose.

A hands-on leader who can develop a strategic vision of the department and has the expertise to develop values and goals for a diverse group of constituents will be successful.  The successful candidate will have a proven record of accomplishment of strong leadership skills to ensure that the improvement process within the department continues, that priorities are established and the goals are met.

The successful candidate will be a person who possesses a strong work ethic, rejects setbacks and values accomplishments highly.  An action-oriented personality that deals with specifics within a broad conceptual framework will be most effective in this position.  This individual will have an appropriate sense of urgency to react to situations quickly and decisively.

Compensation

The compensation plan is based on a competitive base salary commensurate with the experience and the demonstrated accomplishments of the successful candidate.  It will reflect the opportunity at the hospital. The hospital has an excellent employee benefits package, consisting of medical coverage, a dental plan, life insurance, Defined Benefit Retirement Plan and a 403 b program with employer matching.

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