Vice President, Revenue Cycle Operations

Overview

Under general direction of the SVP - Finance, CFO CUC, the Vice President, Revenue Cycle Operations is the health system executive accountable for revenue cycle strategy, operating performance, financial outcomes, regulatory compliance, and organizational capability across Central Health and CommUnityCare. The Vice President establishes enterprise priorities and decision frameworks for patient access, charge capture, coding, billing, claims, accounts receivable, denials, payment posting, patient financial services, revenue integrity, provider documentation support, credentialing and payer enrollment coordination, and revenue cycle informatics.This position holds overall responsibility for translating health system strategy into scalable revenue cycle operations that support specialty care, ambulatory services, safety-net programs, service-line expansion, and evolving reimbursement models. The Vice President leads multiple departments and complex system initiatives; sets objectives, budgets, performance standards, and resource priorities; resolves material operational and reimbursement barriers; and makes or recommends decisions with health system-wide financial, operational, patient, and compliance impact.The Vice President serves as a member of the senior leadership team and strategic advisor to executive, clinical, operational, financial, information technology, compliance, legal, contracting, and analytics leaders. The role represents the health system with payers, vendors, consultants, affiliated entities, and other external partners and is accountable for building a high-performing, integrated revenue cycle department that advances financial sustainability, access, and patient experience.

Responsibilities

Essential Functions:Enterprise Strategy, Governance and Decision-Making•Establish and execute a multi-year health system revenue cycle strategy aligned with enterprise financial, clinical, access, growth, and patient experience objectives.•Define the operating model, governance structure, decision rights, performance expectations, and investment priorities for revenue cycle functions across Central Health and CommUnityCare.• Provide executive direction and make decisions regarding organizational structure, resource deployment, technology enablement, vendor strategy, policies, controls, and operational standards within assigned authority.• Advise executive leadership on revenue cycle performance, reimbursement trends, regulatory risk, service-line readiness, and strategic investments; present clear recommendations and alternatives with financial and operational implications.• Lead enterprise transformation initiatives requiring coordination across multiple departments, affiliated entities, and external partners; resolve competing priorities and escalate material risks when executive action is required.• Identify opportunities for automation, artificial intelligence, workflow redesign, shared services, and technology optimization to increase capacity, accuracy, scalability, and accountability.Revenue Cycle Informatics, Technology and Analytics• Provide executive sponsorship and direction for the enterprise Revenue Cycle Informatics function and Epic revenue cycle governance, including Professional Billing, Claims, Patient Access, Accounts Receivable, and related applications.• Prioritize technology enhancements, reporting development, workflow changes, and analytics resources based on enterprise value, risk, readiness, and operational impact.• Establish a unified revenue cycle data and reporting strategy with standardized definitions, reliable source data, transparent performance reporting, and clear ownership for action.• Direct development of executive and Board-level dashboards, operational scorecards, benchmarking, predictive analytics, and decision-support tools that translate data into measurable action.• Ensure revenue cycle technology, data, and workflows support internal controls, regulatory requirements, business continuity, cybersecurity practices, and sustainable growth.Service-Line Growth and Reimbursement Readiness• Lead revenue cycle planning and readiness for new clinical services, specialty programs, sites of care, provider recruitment, acquisitions or affiliations, and expanded access models.• Approve or recommend go-live readiness based on payer enrollment, contracting, benefit configuration, coding, charge structures, fee schedules, staffing, technology, workflows, controls, reporting, and training.• Partner with clinical and operational leaders to design reimbursement workflows that support efficient care delivery while preserving compliance, documentation integrity, and patient access.• Assess the financial and operational implications of reimbursement models, payer requirements, and service design; recommend mitigation strategies before implementation.• Ensure post-launch monitoring identifies revenue, workflow, compliance, and patient experience issues and drives timely corrective action.Payer Strategy, Contracting and Alternative Payment Models• Partner with payer strategy, contracting, credentialing, finance, and clinical leaders to evaluate reimbursement methodologies, contract terms, administrative requirements, and operational feasibility.• Represent revenue cycle operational requirements in payer negotiations and implementation planning; identify contract provisions or payer practices that create financial, compliance, or access risk.• Oversee operational implementation and administration of fee-for-service, value-based care, capitation, quality incentive, and other alternative payment arrangements as applicable.• Lead executive-level resolution of systemic payer issues involving claims, authorization, enrollment, payment, recoupment, or administrative performance.• Maintain productive relationships with governmental and commercial payers and use performance data to support accountability, issue resolution, and reimbursement improvement.Compliance, Audit and Revenue Integrity• Ensure revenue cycle operations comply with applicable federal, state, Medicare, Medicaid, FQHC, commercial payer, coding, billing, documentation, privacy, and organizational requirements.• Establish effective controls, monitoring, audit response, education, and remediation processes in partnership with Compliance, Legal, Health Information Management, Finance, and Clinical Leadership.• Provide executive oversight of coding compliance, documentation standards, charge integrity, refund and credit balance processes, revenue recognition inputs, and prevention of revenue leakage.• Assess regulatory and payer changes, determine operational implications, and direct timely changes to policies, technology, training, staffing, and workflows.• Escalate significant compliance, financial, reputational, or patient-impact risks and ensure corrective action plans are implemented and sustained.Executive Leadership and Organizational Development• Build and lead a high-performing, integrated revenue cycle department through directors, managers, informatics professionals, analysts, and operational teams across the health system.• Clarify roles, decision rights, and accountability; set measurable expectations; evaluate leadership and organizational capacity; and take action to address performance or capability gaps.• Develop succession plans, leadership pipelines, workforce strategies, and professional development pathways that support growth, retention, and operational resilience.• Lead change and promote a professional, collaborative, inclusive, and results-oriented workplace culture grounded in service, integrity, continuous improvement, and data-informed decisions.• Influence leaders and teams across organizational boundaries, including individuals without a direct reporting relationship, to align priorities and achieve health system outcomes.• Represent the revenue cycle function in executive, governance, Board, payer, vendor, and partner forums; provide succinct reports, analyses, and recommendations.• Perform other duties as assigned.

 

Knowledge, Skills and Abilities:

• Executive leadership and management capability with demonstrated success directing large-scale, complex operations and transformation across multiple departments or entities. 
• Advanced knowledge of end-to-end healthcare revenue cycle operations, reimbursement, payer administration, revenue integrity, coding and billing compliance, and patient financial services. 
• Demonstrated ability to establish strategy, governance, decision rights, operating plans, budgets, performance measures, and accountability systems that produce sustainable outcomes. 
• Ability to evaluate enterprise risks, competing priorities, capital and operating investments, and operational tradeoffs and to make timely decisions within delegated authority. 
• Advanced financial and operational acumen, including budgeting, forecasting, variance analysis, productivity management, reimbursement analysis, business cases, and return-on-investment evaluation. 
• Ability to lead through influence across clinical, operational, financial, technical, legal, compliance, and executive stakeholders, including teams without direct reporting relationships. H
• Advanced capability in performance management, process redesign, change leadership, vendor management, contract implementation, and operational readiness for new services. 
• Knowledge of Medicare, Medicaid, FQHC, commercial payer, coding, billing, documentation, privacy, and other applicable revenue cycle requirements. 
• Ability to use enterprise data, benchmarking, dashboards, and predictive analysis to identify risk, establish priorities, and drive decisions and measurable improvement. 
• Executive communication and presence, including the ability to synthesize complex information into concise recommendations and presentations for senior leadership, governing bodies, and external partners. 
• Ability to establish credibility, manage conflict, negotiate solutions, and maintain effective relationships with payers, vendors, affiliated entities, community partners, and internal stakeholders. 
• Strong judgment, integrity, initiative, adaptability, and accountability in managing sensitive.
• impact, and time-critical matters.

Qualifications

Minimum Education:

• Bachelor's Degree (higher degree accepted) in business, healthcare administration, finance, accounting, or a related field.

Minimum Experience: 

• 10+ years Progressive healthcare revenue cycle experience in a complex healthcare delivery environment.
• 5 years of management experience in healthcare revenue cycle operations. 
• Demonstrated experience leading revenue cycle functions and teams in a complex healthcare environment.
• Experience with governmental and commercial payers, fee-for-service reimbursement, specialty or multi specialty billing, and alternative payment models.

Preferred Licenses and Certifications:

• HFMA CRCR, CHFP, AAHAM CRCE, or comparable revenue cycle credentia.