Vice President, Revenue Management

Job Responsibilities and Duties

Essential Job Functions:

• Works collaboratively with outsourced partner teams to maximize process effectiveness and ensure systems integrity of information through the entire revenue cycle
• Works collaboratively with vendor to evaluate performance against agreed upon SLA targets. Modify scope and SLA targets as necessary in future contracting conversations
• Responsible for entire pipeline of charge capture activities from encounter to correct coding and oversight for ensuring accurate reimbursement for services billed
• Responsible for all revenue integrity functions, specifically related to managed care contract management, charging/charge audit, and appropriate reimbursement
• Responsible for driving process improvement initiatives related to front end revenue cycle functions, in collaboration with the operations leadership and managers. Works with managers on strategies to improve front end related issues
• Manages the monthly AR reconciliation process to ensure that all procedures cases are billed in a timely and correct manner
• Analyzes month end reports presented by billing vendor, identifying opportunities for work process improvements with respect to AR follow-up claims denials
• Oversees and provides input to ensure all systems are functional in categories such as dictionary file, data elements, interface and mapping, payer specificity, file transmission, billing area set, adding/deleting ICD‐10 and CPT codes, etc.
• Coordinates and facilitates compliance audits for the department. Verifies that fee schedules are appropriate against insurance payers’ allowable fees
• Serves as a key resource for changes in payment and coding guidelines from all payers. Educate partners on these continual updates. Responsible for facilitating constant and continual education of the physicians on coding process and changes
• Track and analyze appeals and denials; tracking work effort by the billing vendor to ensure appropriate collection levels on a regular basis. Reviews EOBs as needed to determine/address payer problems. Coordinates efforts regarding authorization issues
• Analyzes weekly charges and payments data to ensure billing vendor is on track to meet established targets for productivity. Pro-actively address charge lag and payment delay issues
• Supervise internal revenue cycle staff and provide appropriate training, coaching, and development opportunities
• Attendance requirements are based on your current role and status of position (FT, PT or PRN). Please direct attendance requirements to your immediate supervisor and/or refer to the Employee Handbook for more attendance/scheduling details/policies

Supervisory Responsibility:

Responsible for the supervision of the Revenue Cycle and Integrity Teams and all revenue vendor relationships

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Qualifications

Education and Experience:

• Bachelor’s degree from a four-year college or university is required; an advanced degree is highly preferred
• Minimum of 10 years of experience in related role in the medical/healthcare billing area, with strong, demonstrated knowledge of the RCM process and business analytic requirements proven within a verifiable record of success
• Business Process Outsourcing (BPO) experience as evidenced by working with a variety of partners to drive outcomes
• Current expertise and understanding with billing regulations and reimbursement methodologies, allocate tasks, and scale operations to align with business priorities
• Strong analytical skill and forecasting skills with demonstrated ability to plan workload
• Advanced skills with Microsoft applications which may include Outlook, Word, and Excel, PowerPoint or Access and other web‐based applications. May produce complex documents, perform analysis and maintain databases
• Direct experience working in hospital or provider setting, including: claims/billing, registration/scheduling, case management, health information management, IT, clinical units/departments, quality, compliance, etc.
• Multi-site and multi-state experience is highly considered
• Presentation skills, including development and delivery of PowerPoint presentations to audiences of various sizes
• Direct experience working in a hospital environment (such as a former Director, Manager or Supervisor of department) or similar experience in consulting experience (relevant experience includes revenue cycle, compliance/quality, clinical departments/units
• Workflow redesign and/or performance improvement projects specific to revenue cycle and/or clinical units