About The Role

The VP, Revenue Cycle is responsible for network-wide end-to-end Revenue Cycle Management as it relates to patient access, registration, authorization, pre-service collections, HIM/coding functions, patient financial services including customer service, and physician billing/coding/customer service with the goal of optimizing reimbursement and maintaining patient information.

This position will proactively identify, develop, and execute critical process improvement initiatives to drive best practice performance and favorably impact accounts receivable, cash acceleration, and net revenue.

Strategy

Develops strategy and oversees programmatic implementation efforts around: insourcing/outsourcing services; tools and technology deployed; managed care contracting, including various reimbursement models such as value-based care, at risk, and pay for performance payment vehicles.
Leads strategy and development of the end-to-end Revenue Cycle centralization for TCHHN.
Leads Revenue Cycle work/efforts surrounding evaluation of implications of new business models and ventures.
Drives and enables hybrid reimbursement models, including value-based care and reimbursement, along with process redesign to support new clinical models along with technology integration across all domains.
Maintains extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers.

Program Oversight

Monitors A/R effectively and ensure aging categories are within established goals and national benchmarks
Ensures effective management of denials by Director of Reimbursement and Manager of HSC and JHMH
Ensures goals and objectives including productivity goals are established and monitored.
Ensures a process is established for reviewing and approving refunds.
Establishes and oversee effective utilization review process.

Compliance/Risk

Oversees Revenue Cycle policy and procedures, to ensure compliant alignment with regulatory and legal requirements.
Provides necessary governance with optimal integration and operational control of disparate Revenue Cycle functions and systems to optimize revenue cycle management performance.
Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems then recommending/implanting solutions.
Serves as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.

KNOWLEDGE AND SKILLS

EDUCATION

Bachelor’s Degree required
Master’s degree in Health Administration, Business Administration, or related field preferred

YEARS OF EXPERIENCE

Required - Minimum of ten (10) years or relevant revenue cycle leadership experience with a proven track record of progressively responsible positions in a complex healthcare related organization. Broad understanding and experience within acute care hospital, behavioral health, physician practice operations, and other ancillary healthcare services.

REQUIRED SKILLS AND KNOWLEDGE

Strong working knowledge of managed care contracting strategies, billing and collection processes and functions, patient access,
Denials Management,
Health Information Management,
cost reporting,
payment modeling,
State/Medicaid rules & regulations
RAC & Government audits
financial and service line reporting experience
general revenue cycle management strategies
industry best practices.