About Tufts Medicine:

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. The health system is the principal teaching affiliate for Tufts University School of Medicine. The strong relationship between Tufts Medicine and Tufts University School of Medicine is evident in our governance, academic and research structure. Tufts Medicine is comprised of the following clinical entities:

·       Tufts Medicine Professional Group (TMPG)

·       Tufts Medicine Integrated Network (TMIN)

·       Tufts Medical Center

·       Lowell General Hospital

·       MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford

·       Tufts Care at Home

Job Overview

This role oversees the functions and personnel in the Clinical Documentation Improvement, HB/PB Coding, HIM Operations, and Utilization Review (UR) departments while implementing enterprise-wide vision. The leader will own, guide, and direct standardization of activities across localized CDI, Coding, and Utilization Review departments. They will provide input and direction to strategic plan and goals to meet imperatives and develop enterprise-wide policies, procedures, and protocols in alignment with Joint Commission, federal, and state guidelines.  Provide input for process design and other implementation and solution activities. Oversee budgets, maintain, and manage cost control. Collaborate with corporate leadership to ensure strategic alignment and objective achievement. Evaluate and interpret CDI and UR variances and trends to strategically align CDI and UR operations.  The position collaborates with Tufts Medicine Leadership including but not limited to Patient Access and Registration; Patient Financial Services (PFS), and Revenue Integrity providing direction on coding-related guideline compliance, processes, edit and denial management efforts. The role utilizes project management skills, clinical knowledge, and understanding of revenue cycle requirements to manage day to day operations, processes, and compliance. This position monitors dashboards, metrics, and trends to evaluate and interpret variances to strategically align middle revenue cycle operations to department key performance indicators and organizational goals.

Job Description

Minimum Qualifications:

1. Bachelor’s degree in nursing or in related field.

2. Ten (10) years of technical healthcare operation experience.

3. Direct supervisory experience.

Preferred Qualifications:

1. Master’s degree in nursing or in a related field.

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.  Other duties and responsibilities may be assigned.

1. Builds successful relationships with key stakeholders; CEOs and Executive Leadership team and leaders across the system.

2. Proposes enhancements to operational processes to improve efficiency and/or effectiveness.

3. Ensures that all departments meet service level agreements, quality standards, and performance goals based on the development and monitoring of cost and process metrics.

4. Advocates for the desired culture in high-level planning and decision making, with a focus on performance accountability and achieving greater operational efficiencies.

5. Develops, leads and manages a diverse team ensuring that succession and development plans are in place to achieve the company’s goals.

6. Applies current knowledge and understanding of regulations, industry trends, current best practices, new developments, and applicable laws to ensure operational and financial effectiveness. Partners to ensure regulatory compliance for all areas of responsibility.

7. Acts as a key participant in the strategic and long-range planning of the organization. Integrate long range plans with operational plans and capital priorities.

8. Analyzes operations to evaluate performance of the team in meeting objectives or to determine areas of potential cost reduction, program improvement, or policy changes.

9. Guides and directs subordinate managers in the HIM, CDI, Coding, and UR areas.

10. Develops, implements, and maintains a system-wide quality management and process improvement program to assure the quality, completeness, appropriateness, and accuracy of coding for all service lines.

11. Develops professional and technical skill set in subordinate staff, and develops ongoing training and education materials for staff and patient education.

12. Schedules and leads monthly Staff meetings.

13. Performs staff evaluations.

14. Attends outside meetings related to Tufts Medicine including the Board of Supervisors, when assigned.

15. Serves on various committees throughout Tufts Medicine.

16. Ensures compliance with all Federal, State, local government, and private industry mandates.

17. Ensures staff are aware and compliant with all applicable laws, regulations, and guidelines.

18. Identifies issues, risks, barriers, and opportunities for improvement related to set responsibility area.

19. Analyzes, interprets, and summarizes pertinent revenue cycle data components, and monitors performance against Key Performance Indicators.

20. Supervises, trains, develops, and motivates subordinate staff.

21. Analyzes and identifies HIM, CDI, Coding, and UR needs to determine appropriate action and make recommendations for problem resolution or procedural changes if appropriate.

22. Develops a structure for innovation and establish cross-departmental collaborations to transform care delivery and the patient/clinician experience.

23. Models leadership behaviors and lead as a unified team to drive system alignment.

24. Directs the strategy, goals and objectives of the department to align with Tufts Medicine’s business plan.

25. Seeks to understand disagreements, ensure that all perspectives from internal and external stakeholders are heard and facilitate a plan for resolution.

Responsibilities under CDI & Utilization:

1. Accountability for success of the CDI program; track and trend productivity and success.

2. Provides day to day oversight of the inpatient, outpatient and ambulatory program.

3. Directs the CDI process flow.

4. Provides CDI Team, physicians and administration ongoing feedback.

5. Provides necessary feedback and conflict resolution to the CDI Team.

6. Collaborates with Physician Liaison regarding physician resistance to the program and develop an action plan to address this if it occurs.

7. Develops physician education strategies to promote complete and accurate clinical documentation and correct negative trends.

8. Designs, establishes and maintains procedures and policies to ensure high bed occupancy and to control bed availability and patient traffic.

9. Ensures compliance with accreditation agency requirements.

10. Ensures compliance with the state requirements/guidelines.

11. Represents UR staff and suggests solutions to identify problems.

12. Ensures quality and quantity of documentation in medical records for UR.

13. Attends treatment staff meetings.

Responsibilities under Coding:

1. Oversees preparation of the budget for areas of responsibility.

2. Prepares an annual statement of goals and objectives in collaboration with subordinates, including Directors/Managers of CDI, HIM, Coding, and UR.

3. Monitors dashboards, metrics, and coding trends to evaluate and interpret coding variances to strategically align coding operations department key performance indicators and organizational goals.

4. Provides timely feedback to providers/coders and take corrective action to ensure education is effective.

5. Works with subordinates to analyze and identify middle revenue cycle needs to determine appropriate action and make recommendations for problem resolution or procedural changes if appropriate.

6. Identifies issues, risks, barriers, and opportunities for improvement related to set responsibility area.

7. Analyzes, interprets, and summarizes pertinent revenue cycle data components, and monitors performance against Key Performance indicators.

8. Identifies continuous improvement opportunities and manage productivity metrics and efficiencies.

9. Builds, manages, and maintains strategic vendor relationships.

10. Establishes regular team meeting cadence to disseminate departmental and/or organizational information.

Responsibilities under HIM Operations:

1. Develops and implements policy and procedure recommendations to meet the needs of Tufts Medicine, its affiliate members and our patients.

2. Oversees preparation of the budget for areas of responsibility .

3. Prepares annual statement of goals and objectives in collaboration with subordinates.

Physical Requirements:

1. Work environment: professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.

2. This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending / descending stairs and operate office equipment.

3. Frequently required to speak, hear, communicate and exchange information.

4. Able to see and read computers displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols.

5. Occasionally lift and/or move up to 25 pounds.

6. Ability to work in confined or open environments.

7. Ability to work independently or in a team environment.

Skills & Abilities:

1. Knowledge of pre-assessment and pre-certification reviews and able to perform appeal reviews.

2. Knowledge of discharge planning resources.

3. Proficient in Microsoft office (Word, PowerPoint, Excel).

Job Profile Summary

​This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing.  In addition, this role focuses on performing the following Patient Access duties: Performs the administrative and financial-clearance duties necessary to facilitate the procurement of clinical services by patients. Collects patient's necessary demographic and financial information from physician offices, acute-care entities, or the patients themselves, schedules services for patients, and handles referrals from primary care doctors to ensure patients are scheduled for recommended appointments/procedures, etc.    A management role that supervises employees focusing on tactical, operational activities within a specified area, with the majority of time spent overseeing area of responsibility, planning, prioritizing and/or directing the responsibilities of employees. Goal achievement is typically accomplished through performance of direct and/or indirect reports.  A role that directs a department or small unit that includes multiple teams led by managers and/or team Leaders.  Responsibilities typically include: ownership of short to mid-term (1-3 years) execution of functional strategy and the operational direction of the Department, problems faced are often complex and require extensive investigation and analysis, and requires ability to influence others to accept practices and approaches, and ability to communicate and influence executive leadership.

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us at careers@tuftsmedicine.org.