The class incumbent reports to the Director of the Division of Business Administration and General Services and is responsible for the management and supervision of the Revenue Management Unit. The incumbent is responsible for the Client Accounting System including update of the system master files, accuracy of data entered and that system is updated to reflect legislative requirements. Work includes responsibility for the development of cost-based rates for all services provided by the department, coordinating the maintenance of cost data and development of statistical data for rate setting. The incumbent is also responsible for coordinating the implementation of methodologies and rates with user agencies and facilities. The incumbent is also responsible for the development and implementation of policies and procedures to ensure the collection of maximum revenues as allowed by law for services provided to departmental clients. Work includes overseeing the development of standard billing and collection function and the training of appropriate departmental staff in such functions. In addition, the class incumbent is responsible for planning and overseeing the conduct of management studies such as operational audits, research in such areas as Medicare and Medicaid coverage and reimbursement issues, feasibility of implementing automated fiscal reporting systems and improved methods for funding fiscal requirements. The incumbent also analyzes current proposed legislation and pertinent state/federal regulatory requirements to determine current and potential operating impact. A significant aspect of the work involves working with departmental employees and managers, officials from other state and federal agencies, third party intermediaries or carriers in order to develop plans and programs resolve problems and determine appropriate courses of action.
Essential functions are fundamental, core functions common to all positions in the class series and are not intended to be an exhaustive list of all job duties for any one position in the class. Since class specifications are descriptive and not restrictive, incumbents can complete job duties of similar kind not specifically listed here.
Direct and oversee the Revenue Management Unit.
Oversee the maintenance of the Client Accounting system.
Develops and maintains rates and charges for health care services provided by departmental facilities.
Oversees and directs the patient billing accounts receivable and collection efforts of departmental facilities and agencies.
Develops, recommends and implements revenue management policies and procedures.
Participates with institutional managers and administrators in the development of fiscal plans and issues relating to operations. Develops revenue recovery/collection mechanisms, policies and procedures.
Plans and oversees the conduct of management studies in order to provide recommendations and plans for revenue management programs.
Works with departmental managers and representatives from state, federal and private agencies in order to coordinate all issues related to Health Care Finance.
Analyzes current and proposed state and federal legislation, rules and regulations in order to determine current and potential impact on the Revenue Management program.
Knowledge, Skills and Abilities
The intent of the listed knowledge, skills and abilities is to give a general indication of the core requirements for all positions in the class series; therefore, the KSA’s listed are not exhaustive or necessarily inclusive of the requirements of every position in the class.
Knowledge of managerial principles and practices.
Knowledge of accounting and budgeting principles and practices.
Knowledge of Medicare and Medicaid regulations.
Knowledge of state laws, rules and regulations regarding revenue management.
Knowledge of Third Party Insurance payors coverage of services and billing requirements.
Skill in supervising and coordinating projects.
Skill in rate setting and cost accounting methods and procedures.Skill in the development and implementation of policies and procedures for revenue management and recovery.
Ability to plan and direct the work of staff.
Ability to oversee the development of data management systems.
Ability to communicate effectively both orally and in writing.
Ability to establish and maintain effective working relationships.
JOB REQUIREMENTS for Health and Social Services Revenue Management Unit Admin.
Applicants must have education, training and/or experience demonstrating competence in each of the following areas:
Three years experience in health care reimbursement which includes reviewing and categorizing claims for proper billing, analyzing cost reports, examining cost containment, and interpreting and analyzing laws, rules, regulations, policies, procedures and standards affecting reimbursement and recovery.
Three years experience in interpreting Medicaid, Medicare, or other third party insurance providers laws, rules, regulations, standards, policies and procedures.
Six months experience in financial administration such as comprehensive analysis of programs, budgets, projects, services, alternatives, and costs; financial planning, revenue generation, revenue forecasting, expenditure forecasting, cash flow management and establishing internal control.
Knowledge of developing policies or procedures.
Knowledge of staff supervision acquired through course work, academic training, training provided through an employer, or performing as a lead worker overseeing the work of others; OR supervising staff which may include planning, assigning, reviewing, and evaluating the work of others; OR supervising through subordinate supervisors a group of professional, technical, and clerical employees.