Vice President of Revenue Cycle

Summary:

The Vice President of Revenue Cycle (RCM) will lead and oversee the entire revenue cycle function for a large occupational healthcare organization, with approximately 32 clinics in 4 states. This senior leader will be responsible for ensuring effective management of the front-end and back-end RCM processes, including insurance verification, authorization, denial management, patient payments, accounts receivable (A/R), and more. The VP will lead a team of internal staff and oversee relationships with several key vendors. The VP of RCM will be a strategic, innovative leader who drives continuous process improvement, automation, and efficiency, while ensuring compliance with industry regulations and improving key RCM performance indicators (KPIs).

Strategy:

• Provide leadership and direction to the entire RCM function, encompassing front-end (insurance verification, authorization, charge capture, and denial management) and back-end (patient and insurance payments, collections activities, accounts receivable management) operations.
• Develop and implement an overarching RCM strategy that supports organizational growth, optimizes financial performance, and aligns with the company's goals.
• Lead an internal team of approximately 65 current professionals focused on customer service, vendor management, audits, and process improvement.
• Identify, develop, and execute strategies to improve key RCM KPIs, such as Days in A/R, denial rates, net collection rate, and patient satisfaction

Process Improvement and Efficiency:

• Lead initiatives for RCM process optimization, including automation and integrating innovative technologies to streamline workflows and increase efficiency.
• Lead RCM integration of newly acquired practices into MBI, including assessing current RCM operations and providing recommendations for future state RCM operations.
• Collaborate with vendors and internal teams to drive the adoption of new technologies and best practices across all RCM functions.
• Develop and execute a strategic roadmap for continuous improvement in revenue cycle processes, addressing gaps in operations and improving efficiency.
• Evaluates current RCM flow and EMR utilization across all markets to form best practice utilization procedures and roadmap.
• Evaluates current RCM management, staff, systems, and locations to determine optimal use of company resources.
• In conjunction with Human Resources and Operations leadership, help develop training materials for current and new staff members and providers to drive compliance and adherence to best practices.
• Coordinates with the Clinic Operations leadership on related needs or any issues or needs to improve operational flows.

Financial Oversight & Reporting

• Oversee all aspects of financial performance related to RCM, including charge capture, cash collections and reconciliations, patient payments, denials management, follow up and collections activities, and accounts receivable management.
• Develop ongoing reporting to track, analyze, and report on key RCM metrics to executive leadership, identifying trends and making data-driven recommendations to improve performance.
• Collaborate closely with the finance and accounting team to ensure accurate forecasting, budgeting, and financial reporting related to revenue cycle activities; participate in annual financial statement audit activities, including meeting with auditors and providing data, samples, and other information as requested.

Compliance and Risk Management:

• Ensure all RCM activities adhere to federal, state, and industry regulations, including HIPAA and other patient confidentiality laws.
• Implement and maintain audit processes to identify and mitigate risks within the RCM function, ensuring compliance and reducing potential financial exposure.
• Ensure staff and provider training is consistently and regularly provided.

Minimum Qualifications:

These are general guidelines based on the minimum experience normally considered essential to the satisfactory performance of this job. Individual abilities may result in some deviation from these guidelines.

• Required:

B.S., B.A. Healthcare Administration, Finance or Business Administration

• Preferred:

Master's degree in healthcare or business administration

• Minimum Experience Required:

10 years of Revenue Cycle Management
7 years Leadership Experience
Previous experience supervising employees

• Preferred:

Previous experience managing vendor teams

• Knowledge Skills and Abilities

Strategic thinking and problem-solving skills
Strong communication and negotiation abilities
Expertise in managing offshore and third-party vendors
Data-driven decision-making and analytical skills
Change management experience, especially in driving automation and technology adoption in RCM functions
Team leadership and management capabilities

Work and Location:

• Travel is required as needed to evaluate clinical processes as demanded by market requirements.
• Salaried, Exempt position. Work hours may vary.