The Vice President of Revenue Cycle leads overall strategy, optimization, implementation and performance measurement of revenue cycle operations.
This includes oversight of the following areas: managed care and payer contracting and relationships, credentialing of providers, “front office “operations including E-scheduling, registration, insurance verification, financial counseling, and billing and revenue collection functions. Billing and revenue collection includes creating and updating of charge master, charge capture, health information management and coding, clinical documentation improvement to enhance collection, patient financial services, provision of sliding scale and other discounts, and overall collection of patient service revenues across multiple organizational facilities and service lines.
Maximize point of service collections, maximize gross collection percentage, sustain ideal account receivable, create and maintain written policies and procedures in accordance to organization, HRSA and other contractual requirements, ensure current and complete insurance enrollment, cultivate and maintain third party relationship and negotiate and manage Medicaid, Medicare, commercial insurance and other payee contracts. Ensure consistent compliant billing practices in conjunction with all governmental regulations and other third-party payer requirements.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:
- Develop and implement controls and measures to ensure accurate and timely billing and collections, in accordance with established internal and third-party payer requirements.
- Continuous Improvement in policies and procedures, also strategies and services (establish, record, implement) for all revenue cycle activities, including follow-up on third-party approvals and collection of overdue patient accounts.
- Analyze workflow and demand within the revenue cycle and set the organizational structure to meet this demand.
- Works closely with the organization’s other key leaders to implement effective systems and processes that will enhance the revenue cycle function.
- Create and implement strategies to maximize revenue by providing best practice support for efficient processing of patients and scheduling of appointments.
- Manage and direct revenue cycle functions for all patient revenue streams, including insurance reimbursement, collections and patient payments.
- Manage actions relating to delinquent accounts, collection agencies, special adjustments, and/or write-offs.
- Generate projections and trends and analyze revenue information using Electronic Health Record reporting
- Align revenue cycle processes with organizational mission, setting budgetary and performance benchmarks and goals for Revenue Cycle and ensuring the team have clear expectations of the objectives.
- Report status trends to senior leadership and board members.
- Oversee process of resolving issues and outstanding problems concerning Accounts Receivable (AR) management and revenue cycle process.
- Monitor Payer Enrollment to ensure timely reimbursement
- Cultivate and maintain payer relationships
- Negotiate payer contracts and assure PCH and payers adhere to contract terms, PCH maximizes revenue through pay for performance and other payment incentives.
- Organize periodic external audits to prevent internal control weaknesses.
- Utilizing the support of Human Resources, ensuring the most competent candidates are identified and recruited for the organization.
- Utilizing the support of Human Resources, ensuring all staffed are assessed and developed to meet their maximum potential.
- Ensure all revenue cycle personnel are educated and involved in the performance of the organization.
Supervises the Client Financial Services Coordinator, Coordinator of Benefits & Authorizations, and The Director of Clinical Support.
Carries out supervisory responsibilities in accordance with the organization’s policies and applicable laws. Responsibilities include hiring and training new staff; planning, assigning, and directing work; evaluating performance, providing coaching and development, addressing concerns and resolving problems, and managing employee time cards and PTO requests.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The required skills listed above are representative of the knowledge, skill and or ability required. Reasonable accommodations may be made to enable an individual with a disability to perform the essential duties and responsibilities.
EDUCATION AND EXPERIENCE
Bachelor’s degree in Healthcare, Business Administration, Finance or another related field required. Master’s degree preferred. Certified Coder preferred. Equivalent Combination of experience and education may be considered in lieu of required degree.
- Five to seven years of experience in Revenue Cycle
- At least four years of management or supervisory experience required
- Healthcare Billing Laws, Medical Terminology/abbreviations
- Professional Billing Policies, Procedures, Processes and Protocols
- ICD-9, ICD-10, HIPAA and EHR implementation
- Full Revenue Cycle Process including; Payer Enrollment, Scheduling, Registration, Accounts Receivable management
- Medicaid, Medicare, and Sliding Fee programs
- Electronic Health Record including functionality and reporting
- Familiar with eClinicalWorks and Carelogic EHR preferred
- FQHC or non-profit healthcare experience preferred
Demonstrated Skills & Interests:
- Strong Customer Service
- Organizational and Analytical Skills
- Relationship Development – Demonstrates the ability to work collaboratively with the various departments to ensure training programs and that consistent standards and industry best practices are implemented. Breaks down barriers and has open communication among and between departments.
- Strong process improvement skills
- Superior negotiation and decision-making skills
- Personal and professional integrity
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