DIRECTOR, CLINICAL OPERATIONS

Arbuckle Memorial Hospital has determined this is a safety-sensitive position. The tasks or duties assigned to this job could affect the safety and health of the employee or others.

Summary:

Manage and oversee the daily activities and business of the clinic. Maintain inventory control, clinic manuals, monthly meetings, insurance credentialing, QI reporting, and program evaluations.

Qualifications:

Communicate in an effective manner, follow written or verbal instructions and demonstrate good interpersonal skills to deal with team members, patients and families Possess skills necessary to understand medical records and procedures and to communicate effectively with patients and staff Maintain discretion and confidentiality in communications Familiar with policies and procedures regarding reporting and release of protected health information (PHI) Knowledge of medical billing processes Knowledge of level I Healthcare Common Procedure Coding Systems (HCPCS) comprised of Current Procedural Terminology (CPT-4) and International Classification of Disease (ICD) codes

Knowledge of Medicare, Medicaid, Insurance Managed Care Plans and Worker's Compensation Essential Duties and Responsibilities:

Provides oversight to ensure the phone, triage calls and walk-in patients are handled appropriately. Provides oversight to ensure all diagnostic reports, correspondence, transcriptions, etc. is filed in the patient chart. Maintains personnel schedules and vacations with little or no overtime. Provides oversight to ensure all required logs are being completed accurately and in a timely manner. Ensures the completion, storage and security of all clinic medical records. Monitor daily deposits and reconciliations. Provides oversight to ensure charges for services rendered are properly entered into the computer billing system. Manages Accounts Receivable effectively. Monitors receivable for incorrect contractual allowances, non-covered services and payments recorded on incorrect date of service. Prepares adjustment report when necessary for approval. Monitors credit balances, prepares a request for refunds as needed and presents for approval. Reads and monitors bulletins from plans subscribed to for changes and updates in claims submission. Fields and answers questions from patients regarding accounts. Replies to any inquiries in a timely manner. Assists in securing any temporary employees required to cover vacation/sick leaves. Prepares performance reviews for the clinic staff on a timely manner and maintains thorough written reports regarding any discussions, reprimands, etc. with clinic staff regarding professional insufficiencies or behavioral issues. Maintains inventory control (along with nursing staff), prepares a purchase order for medical/pharmacy purchases and when applicable reviews all packing lists for accuracy giving lists and invoices to Hospital Business Office. Supervises and ensures yearly inventory count is systematically counted, priced, extended and totaled. Maintains updates for all clinic manuals. Monitors and prepares quality assurance reports, attends monthly meetings and prepares minutes of clinic meetings. Monitors Exposure Control Manual to ensure all employees education requirements are current; all immunizations, etc. are current for all professional and non-professional staff. Completes special projects that may require defining problems, determining work sequence and summarizing findings. Ensures the department complies with the rules and regulations of HIPAA, RHC, State and Local laws. Responsible for the implementation of and compliance with all safety policies and procedures within the department. Attend continuing education classes as requested and required. Maintain electronic health record software system and monitor for efficiency and upgrades. Miscellaneous duties as assigned requested and required.

Education and/or experience:

Bachelor's degree in related field required. Master's degree preferred. 3-5 years of experience in practice management preferred. Supervisory experience preferred. Physician office coding and billing experience preferred.

Work Environment:

Employee is regularly required to stand, walk, sit, ascend and descend stairs, possess ability to handle, finger or feel objects, tools or controls; reach with hands and arms. Employee must frequently be able to lift 25 pounds from the floor to waist level and may occasionally be required to lift 50 pounds. Specific vision abilities include close vision and the ability to clearly focus vision.