Steward of Our Financial Enterprise
How does working as a flight steward prepare one for managing the largest departmental billing and financial operations at the NYU Medical Center? Ask Felix Okhiria, M.P.A., M.A., C.C.P., the Department of Radiology’s Administrator for Business Services and he will state that it’s all about people — guiding and motivating the individuals with whom you work, and serving patients. He will also indicate that it takes constant, others might say maniacal, attention to detail. In the eight years during which he has led this effort, Mr. Okhiria has done the incredible, focusing both on the people and the details, as demonstrated by doubling departmental revenue in the last five years, while at the same time reducing the unpaid accounts receivable.
Mr. Okhiria did not take a direct or easy path to his current position of responsibility. He was born in Nigeria to the chief of the Ekpoma village, near Lagos. His father may have been the chief, but it was his mother who instilled in her six children the drive to succeed and the desire to leave Nigeria for increased opportunities. After completing high school, and wanting to see more of the world, Mr. Okhiria became a flight attendant for Nigeria Airways, primarily on their overseas routes to Europe and the United States. In 1984, he decided that it was time to leave the high-altitude life and immigrated to the United States.
Over the next 14 years, Mr. Okhiria joined the American workforce and simultaneously obtained an American higher education. He received four degrees during that time: an associate’s degree in Finance from the Borough of Manhattan Community College, a bachelor’s degree in Finance from Baruch College, a master’s degree in Industrial Organizational Psychology from Teacher’s College of Columbia University, and a Master of Public Administration degree from the Robert F. Wagner Graduate School of Public Service of New York University. At the same time he began to work on the financial side of healthcare, first as Billing Supervisor in the Radiology Department of Columbia University’s College of Physicians and Surgeons, then as Billing Manager for the Obstetrics and Gynecology Department of the Cornell University School of Medicine, followed by a detour to New Haven, Connecticut as Administrator for Billing and Clinical Operations for the Department of Surgery of the Yale University School of Medicine. He was then recruited to NYU Medical Center by the Department of Radiology to manage all its billing and financial operations.
Over the last eight years, Mr. Okhiria has assumed increasingly more responsibility for the financial aspects of the Radiology Department. He oversees and manages the administrative and billing aspect of every examination performed in the department. The chain of economic activity is initiated when a patient calls the Radiology scheduling group to make an appointment. Not only does the scheduling staff have to accurately record all of the patient’s demographic and clinical information, they have to assure that the various rules and regulations (eligibility, pre-authorization, etc.) of the insurer are met; performing an examination that will not be paid for because of a technical or administrative oversight is an avoidable mishap!
The Business Office Managers. (from left to right) Cassandra Maragh, Dawnette
Simpson, Ilene Rattner, Astrid Jean-Loius, Peggy Francis, Marlon Ketani.
Felix Okhiria, M.P.A., M.A., C.C.P., Business Services Director. Behind Mr. Okhiria is art from the Benin tribe in the Midwest section of Nigeria. Next to
the carvings and masks is a portrait of his 5-year-old daughter, Ehiaghe Enivie Okhiria.
After the examination is performed and interpreted, the responsibility shifts to the billing department. The report is read and the appropriate procedure (CPT) and diagnosis (ICD-9) codes are assigned. If the information necessary to correctly make these assignments is not available on the report, then additional checks of the clinical information are made to allow billing of the most accurate and specific codes possible, ensuring the highest level of appropriate reimbursement. At this point the claims processors take the codes and create an electronic bill that is sent to the insurance company or clearinghouse. When the receipt comes in, the payment posting staff record the disbursement as well as any contractual allowances and create bills for secondary insurance or patient responsibility as needed.
The largest unit in the billing department is the accounts receivable (A/R) follow-up team. It will come as no surprise to anyone in healthcare that many of the bills submitted by our department to the various insurance entities are either not paid or are paid incorrectly. The A/R group is constantly investigating each underpayment, calling the appropriate company, providing additional information, resubmitting claims, and on and on. Keeping track of these claims — over 500,000 per year — and persisting in obtaining payments is essential to make certain that the department receives its rightful income based on services provided.
Mr. Okhiria also assumes a leadership role in negotiating our contracts with the managed care plans. He performs this role in conjunction with the University Physician Network (UPN) and its professional team, who represent not only the Radiology Department but most of the NYU physicians. The focus here, of course, is the per-procedure reimbursement rate, but Mr. Okhiria and the UPN team go beyond this goal to developing and procuring contracts that contain the appropriate legal language to secure prompt payment, protect our clinical ability to perform the appropriate and most complete examination possible, and provide reimbursement for ancillary services (such as the utilization of non-ionic contrast material).
Finally, Mr. Okhiria directly supervises the financial management of the Radiology Department. This huge undertaking, ranging from developing the annual budget with the School of Medicine Financial Office to tracking all income and expenses on a monthly basis, encompasses thousands of data entries, each of which needs to be verified and reconciled. Part of this responsibility includes business planning — that is, developing the financial business plans for our new efforts, both new clinical offerings (e.g., cardiac CTA) and new facilities (e.g., the outpatient minimally invasive interventional radiology center under development, or the Center for Biomedical Imaging research facility).
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