Vice President, Revenue Cycle Management Job at American Family Care Corporate Office
Summary The Vice President of Revenue Cycle Management will report directly to the Chief Financial Officer and be responsible for day-to-day guidance of the Revenue Cycle Management team supporting a multi-unit, multi-state, multi-TIN operation. In this role, the VP is responsible for working directly with government and third-party billers to ensure billers are setting up monthly charges, processing claims, and maintaining collection goals. It has a continuous and consistent presence in the assigned facilities to provide support, review processes, provide feedback and identify areas of opportunity. The Vice President also interacts with company executives and external stakeholders (auditors, banking partners, other third parties, etc.).
Essential Duties and Responsibilities
- Oversee the operations of the RCM department, including the design of an organizational structure adequate for achieving the department's goals and objectives
- Maintain knowledge of Revenue Cycle best practices ensuring high productivity and proficiency standards are met.
- Promote a culture of collaboration between the RCM Team, clients and practices and serve as a positive role model for Revenue Cycle.
- Monitor performance improvement plans to make sure they are developed and implemented.
- Understand and stay abreast of payer requirements and changes in the industry and communicate those changes as well as the financial impact to local leadership.
- Identify process flow or operational structure problems impeding financial outcomes, propose solutions, and collaborate with department to implement corrective actions.
- Work with internal staff and external vendors to automate processes and drive continuous improvement.
- Manage incoming phone calls by responding to requests and assisting with inquiries.
- Possesses an understanding and has experience in offshore Business Process Outsourcing (BPO) leadership and management - how to engage, negotiate, hire, and contract with BPOs.
- Resolve problems by clarifying issues; researching and exploring answer and alternative solutions; implementing solution and /or escalating unresolved.
- Run projects, determining root cause of issues surrounding, providing resolution and stabilization plan, as well as monitoring status post project.
- Identify trends and issues, improve payment capture by addressing issues related to coding errors, billing denials, payment posting, claim disputes, bad debt, and write-offs due to coding edits, missing charges, and charge capture holding bins/task lists, as well as develop and monitor corrective action plans with practice management.
- Maintain continuous understanding of organizational payer contracts, fee schedules and related activities.
- Monitor performance with KPIs- such as registration accuracy, denial rate, utilization, recoupments, charge reconciliation and accuracy, and late charges.
- Report on cash collections and variance to goal with detailed explanation, A/R greater than expected days with root causes, denials trending by payor and state and root cause, recoupments by payor and root cause.
- Manage provider credentialing, onboarding, and enrollment
- Obtain delegation with payors that permit delegation
- Payor Reimbursement Contract negotiations
- Provide day-to-day management of supervisors of Auditing, Payment Processing, Reimbursement, and Customer Service.
- Communicate in a way that promotes trust and credibility between RCM and leadership and strives to strengthen relationships for positive outcomes.
- Ensure high levels of performance through selective hiring, training, evaluation, and motivation
- Other duties and responsibilities as assigned.
- Bachelor’s degree or equivalent combination of education and experience.
- Certified Revenue Cycle Professional (CRCP) or Certified Revenue Cycle Representative (CRCR) is a plus
- 5 to 10 years of progressively responsible claims management experience with at least 5 years of supervisory experience, including supervision of managerial staff
- Strong management and organizational skills
- Comprehensive knowledge of billing & coding, reimbursement, accounts receivable, and collections in an outpatient environment, preferably in primary care.
- Strong computer skills including experience in Electronic Health Records and Patient Management systems. Proficient use of Microsoft Office products, especially Excel, is required.
- Multi-location experience preferred
- Public accounting experience a plus
- Experience with process improvement and ability to identify opportunities for efficiencies.
- Experience in denial management, payment variance and collections.
- Excellent communication, interpersonal and organizational skills
- Self-motivated, self-directed, and detail-oriented
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