DescriptionThe Opportunity Chief Medical Officer, Revenue Cycle The Chief Medical Officer, Revenue Cycle, serves as the key senior physician executive supporting revenue cycle functions and partners with the System CMO and PEC (Physician Executive Counsel) to advance physician and APP engagement in utilization management, denials management, clinical documentation integrity, care continuum integration, and related activities across inpatient, ambulatory, and post-acute settings.
The Chief Medical Officer, Revenue Cycle serves as the physician executive sponsor and medical director for those areas, providing clinical leadership, advocacy, consultation, and physician engagement. This responsibility includes Coding, Health Information Management (HIM), Denials Management, and other mid-revenue cycle functions, helping ensure operational decisions are informed by clinical expertise and aligned with organizational quality, compliance, documentation, and financial objectives.
Reporting Relationships Reports to: UCHealth System Chief Medical Officer, with a dotted-line relationship to the Vice President, Revenue Cycle.
Directed accountability: Physician Advisor Program; Clinical Documentation Integrity and documentation education; Utilization Management; denial and appeal support; centralized call center for transfers, direct admissions, and consultations; and Care Continuum Integration.
Matrixed accountability: Denials Management; Health Information Management; Coding; and Revenue Integrity.
Scope of Responsibility Directed Accountability: Physician Advisor Program- CDI and Documentation Education
- Utilization Management
- Denial and Appeal support
- Care Continuum Integration
Matrixed Accountability: Denials Management- HIM
- Coding
- Revenue Integrity
- Call center for transfers, direct admits and consultations
Key Domains of Responsibility Clinically Focused Mid-Revenue Cycle Physician LeadershipPhysician Advisor Program- Utilization Management
- Peer review
- Clinical Documentation Integrity
- Capacity Management
- Clinical validation and medical necessity
- Denials, audits
- Leadership of AI-enabled physician advising programs
CDI- Chair of system CDI steering committee
- Escalation for coding and CDI adjudication
- Medical Direction for Coding functions
HIM Medical Direction for HIM functions
System Capacity Management & Access (Dyad with VP Patient Logistics)- Enterprise-wide hospital capacity management and throughput
- Oversight of centralized access and intake functions (e.g., DocLine)
Care Management & Navigation (Dyad with VP Care Continuum)- Oversight of care management, social work, and related functions
Post-Acute Care & Care Continuum Integration- Oversight of post-acute care strategy and performance
Managed Care and Contracting Support- Advise contract negotiations and reimbursement strategy discussions
- Provide clinical input regarding payer policies
- Evaluate financial and clinical implications of proposed contract changes.
- Closed-loop feedback to frontline clinicians, quality, revenue cycle, and contracting
Ambulatory Performance- HCC accuracy
- Access and throughput in relation to recent hospitalizations and avoidable utilization
- ED utilization, post-acute utilization, and readmissions
Physician Engagement & Governance- Faculty, employed, and independent physician and APP alignment
- Member of PEC
Qualifications- MD or DO; board certification and Colorado medical licensure required
- At least 10 years of physician leadership experience
- Leadership position in a national or regional physician organization preferred.
- Experience in financial management and an understanding of healthcare economics.
- Understands all aspects of clinical quality: optimal, efficient, patient-driven processes of care; reliable, safe and effective care; and optimal health-related outcomes for individuals and populations.
- Experience that demonstrates knowledge of process improvement infrastructure including how to implement decision tools, clinical protocols and guidelines and care management outcome assessments.
- Providing strategic direction for the hospital and health system on issues related to clinical program development.
Pay: $397,924 - $596,876 annual base pay. Pay is dependent on applicant's relevant experience
