VP Revenue Cycle Management

Our client, a large medical practice is in search of a VP - Revenue Cycle Management.

Under the direction of the Chief Operating Officer, this role is responsible and accountable for the strategic planning, leadership and ongoing continuous quality and process improvement for the revenue cycle operations. S/he will ensure optimal coordination of the following components: physician credentialing, prior authorization, charge entry, coding, billing, collections, denials management and billing compliance.

Essential Responsibilities:

Leadership, Staff Management and Organizational Strategy

• Promotes and supports a working environment consistent with the standards, values and culture of the company.

• Provides supervision, support, and guidance to direct reports; identifies and creates leadership and professional development opportunities for direct reports.

• Leads the Revenue Cycle in planning, coordinating and executing policies, procedures and strategies for the Revenue Cycle Department

• Partners with Senior Leadership, physicians and other stakeholders to design and plan strategic initiatives, goals and objectives and sees that each is carried through to successful implementation/completion.

Practice Management systems, telephones and other RCM Technology

• Partners with Senior Leadership to assess and implement technology to enhance revenue cycle management and or increase staffing efficiencies

• Provides and/or supports project management and implementation of all revenue cycle management-based technology Initiatives

• Ensures integrity of the RCM functions and related processes to minimize organizational risk

• Ensures systems and processes are in place to maintain and support the use of RCM-related technology

Corporate Accounts Receivable Management and Reporting

• Create, update and publish reports monthly to Executive Management and Finance Committee providing detailed analysis and trends for everything related to the collection of patient revenue

• Provide ad-hoc reporting and analysis for any situations that require such analysis as requested by Executive Management or by the physicians.

• Provide summary level reports to RCM mangers (direct reports) as needed to assist with the planning and management of their respective departments.

• Provide situational analysis as required to determine the financial impact of both internal and external policy and procedural changes sufficient to aid in strategic planning and response.

• Create Patient Revenue Forecasts sufficient for use in strategic planning and budgeting.

• Monitor patient revenue against established goals to ensure maximum cash flow.

• Oversee the analysis and recording of revenue adjustments, write offs and denial activity; provides reporting on trends to management along with suggestions to mitigate future write offs and denied claims

• Provide sound financial analysis of third-party payor activity as necessary to make strategic decisions concerning payor contracting.

• Other ad-hoc analysis as required.

Revenue Cycle Management

• Provides direction and oversight of Revenue Cycle Operations, including but not limited to credentialing, prior authorization, charge capture, billing, claim follow-up and collections, payment application, and denials management

• Develop strategies across all functional departments to maximize cash collections, reduce days in AR, and reduce denial and adjustment rates

• Partner with physicians, executive leadership and all other managers throughout the company regarding all aspects of the revenue cycle process

• Tracks and monitors key performance indicators; reports key findings to appropriate leadership and stakeholders across the organization

• Ensures systems and processes are in place to ensure complete compliance with contract requirements around submission of claims; including service provision/documentation, established fee schedules, credentialing, and site enrollments

• Partners with the Managed Care Team to manage payer contracts and support payer relationships

• Provides guidance and supports enrollment and payer credentialing efforts

• Provides oversight for all collaborations with financial leadership, on the general ledger close as it relates to revenue, accounts receivable and billing

• Ensure internal controls, policies and procedures are consistent state and federal law, compliance plans and HIPAA

Other Responsibilities:

• Must assess the resources of the department as well as the related requirements of the company: must then coordinate and disseminate staff assignments as needed to match the two.

• Create and maintain a yearly budget for all RCM related departmental staff and activities.

• Laisse between company and its third-party payors.

• Develop, measure and manage of all expectations, goals and objectives for all RCM department managers and ensure that each aligns with the standards, goals and objectives of the company.

• Develop metrics, key performance indicators and benchmarks to gauge the performance of individual staff members as well as the overall performance of the department.

• Responsible to hire and fire staff, and provide guidance, development and coaching as well as any needed disciplinary action to that staff through yearly performance reviews, ad-hoc meetings and/or progressive disciplinary structure.

• Must monitor and report on departmental issues and ensure Senior Management is aware of any situation that may impact the company.

• Other duties as assigned by the COO or physician leadership.

Essential Skills and Core Competencies:

• Must be extremely organized and detail oriented.

• Must be able to read and comprehend all related financial reports, spread sheets and budgetary information and be able to translate this information into actionable items.

• Must exhibit sound decision-making skills; particularly under pressure.

• Excellent Problem solving and organizational and analytical skills

• Excellent verbal and written communication skills.

• Ability to manage multiple projects simultaneously; including the establishment and adherence to related timelines and budgets

• Ability to be an effective communicator who can lead and or be an active participant in related Committees.

• Knowledge of HIPAA, OSHA and or the ability to be trained and follow these guidelines at all times.

Education and Experience Required:

• Bachelor’s Degree in finance, Accounting or other related field required.

• Master’s degree preferred.

• Ten (10)+ years of RCM experience, with five (5)+ years in senior leadership managing physician receivables at a large, multi-specialty/multi-location practice or health system.

• Proven experience in Physician Revenue cycle.

• Familiar with Medical Terminology.

• Experience with Electronic Health Records (EHR). Experience with Athena preferred.

• Ability to manage multiple work streams, projects, tasks and goals.

• Knowledge and experience with industry charge methodology, billing and collection regulations

• HFMA certification (Certified Specialist Physician Practice Management (CSPPM) or Executive of Healthcare Revenue Cycle (EHRC)) preferred.