VP, Revenue Cycle Management

VP, Revenue Cycle Management

JOB SUMMARY: The VP Revenue Cycle Management provides leadership and direction over all areas of the revenue cycle throughout the organization, from pre-visit insurance verification through the registration process, coding, post-visit claim filing, accounts receivable (A/R) oversight, denial management, medical records supervision, and customer service administration.

REPORTS TO: Chief Financial Officer

ESSENTIAL JOB DUTIES PERFORMED:

• Directs strategic planning, strategic goals, and objectives in the revenue cycle department.
• Establishes internal controls to ensure compliance with Medicare, Medicaid, and all other federal and state regulations relating to coding, billing, insurance claims and collections, business office operations, and Health Information Management (HIM).
• Educates management and staff on revenue cycle standards and provide timely feedback of key performance indicators.
• Maximizes the use of available technologies to insure that all performed procedures are reconciled to billed claims, improve revenue cycle workflow and maximize collections.
• Standardizes revenue cycle reporting to include benchmarks and key performance indicators for all phases of the revenue cycle.
• Provides financial data to company executives on a continuing basis, including analysis and operational planning.
• Monitors and coordinates month end closing procedures with the Controller within the required time frame.
• Maintains strictest confidentiality.
• Complies with all State, Federal, professional regulations as well as company and departmental rules, polices, and procedural manuals.
• Establishes processes to ensure the integrity and quality of data throughout the revenue cycle.
• Provides direct oversight of revenue cycle including payer enrollment, charge capture, financial clearance house, coding, billing, cash reconciliation and collections of accounts receivable from payers and patients.
• Collaborates with Information Management by improving the system support to enhance the revenue cycle.
• Performs ongoing trend analysis and champions revenue cycle improvements.
• Provides financial analysis for, and actively participates in, the review and negotiation of third party payer contracts.
• Prepares monthly analysis and A/R reports; makes decisions regarding the collectability of A/R and oversees collections and bad debt write-offs; makes recommendations to facilitate the keeping of Days in A/R at acceptable levels.
• Maintains up-to-date expertise and knowledge of the healthcare industry including billing laws, rules, regulations, and developments necessary for the organization to make informed business decisions.
• Provides for coding education for physician practices.
• Establishes operating budgets for areas of oversight; ensures that operations occur within approved budgetary constraints.
• Oversees the provider credentialing and payer enrollment team and processes, manages to timeliness metrics.
• Performs other job duties as assigned.

JOB-RELATED PROFICIENCIES:

• Knowledge of Medicare, Medicaid, and other federal and state regulations pertaining to insurance requirements, regulatory reimbursement, patient billing, and collection, etc.
• Ability to analyze, assimilate and proactively anticipate factors with potential organizational receivables and reimbursement impact. Knowledge of CAP, CLIA, State Regulations, HIPAA, Safety and OSHA Regulations. Knowledge of insurance claims processing.
• Knowledge of electronic billing and remittance processes.
• Knowledge of medical terminology and CPT codes.
• Knowledge of all contracted insurance plans within six months of hire date.
• Gains expertise of A/R billing system; drives systems efficiencies, enhancements, and rollouts,

PROFESSIONAL/COMMUNICATION:

• Exhibits excellent leadership and management skills.
• Establishes and maintain positive relationships with employees, physicians, vendors, clients, and external agencies.
• Projects a professional manner and image.
• Adheres to ethical principles; recognizes and respects cultural diversity.
• Demonstrates initiative and responsibility.
• Prioritizes and multi-tasks; manages time efficiently.
• Works as a team member; adapts to change.
• Effective, clear, and persuasive oral and written communication skills with individuals and groups; adapts communication for optimal understanding.
• Maintains licensures/certifications as appropriate for position.

REQUIREMENTS:

Bachelor's degree in relevant field required; MBA preferred.

Minimum 5 years of healthcare Revenue Cycle Management experience; 7 years of healthcare Revenue Cycle Management experience preferred.

Availability to travel up to 15% of the time.