JOB SUMMARY: The Vice President serves as a strategic leader to oversee revenue cycle management (RCM), implementation of new RCM software, performance analysis, transition, payer relations and contract implementation in a CCBHC environment. The VP will drive, enhance, streamline, automate, and optimize the functions of the revenue continuum following industry best practices. Adopt lean office methodology, automation, and technology, and data analytics to streamline and advance end-to-end processes. Stay abreast of industry trends, advancements in revenue cycle management, technology, access management, and payer contracting including managed care. This position must operate within the context of the federal and state regulations and guidelines, as well as those required by a variety of insurance companies as defined in their agreements and contracting guidelines. The VP will collaborate closely with other departments and clincial leadership. Because of the inter-department and multifunction dependencies, strategic leadership with deep understanding of revenue cycle management and exceptional communication skills will be essential in driving efficiency, accuracy, and compliance within operations.
POSITION SPECIFIC DUTIES & RESPONSIBILITIES: General Responsibilities
- Create synergies and streamline workflows across the revenue cycle, implementing efficient and compliant processes. Alert F&CS leaders to impactful developments, maintain Key Performance Indicators, and contribute to strategic planning, budgeting, and work plans.
- Oversee the revenue cycle management team, optimizing end-to-end operations, including enrollment, billing, payment processing, denials management, and collections. Implement best practices to minimize billing errors and collaborate with senior clinical leadership for performance improvement.
Revenue Cycle Management
- Lead the billing process, ensuring coding accuracy, compliance, and timeliness. Drive automation and uniformity through technology, continuously improving revenue cycle performance and adhering to policies and procedures.
- Chair the Revenue Cycle Committee, leveraging business intelligence to analyze trends, reduce claim denials, and identify process improvements.
Performance Analysis and Reporting
- Establish and report on revenue cycle KPIs, defining performance expectations and providing routine feedback. Use business intelligence to optimize revenue cycle performance.
- Consistently report on revenue cycle performance, ensuring transparency and accountability.
Medicaid Managed Care Oversight
- Manage Medicaid MCO contracts, ensuring compliance with guidelines and regulations. Analyze performance metrics, ensuring billing practices align with contract terms.
- Collaborate with internal departments and external partners to optimize contractual arrangements and resolve issues.
Payer Relations and Contracting
- Serve as primary liaison, maintain relationships, and facilitate communications.
- Monitor contract performance, resolve reimbursement issues, and recommend new payer relationships or products.
Regulatory, Risk Management, and Compliance
- Ensure adherence to healthcare regulations, coding guidelines, and billing compliance standards. Collaborate with compliance and legal departments to develop policies and educate team members.
- Support staff training, and maintain strategies to identify and analyze organizational risks, alerting F&CS leadership as needed.
QUALIFICATIONS EDUCATION: - Bachelor's degree in Healthcare Administration, Business, Finance, or a related field is required.
- Master's degree preferred
EXPERIENCE: - A minimum of 10 years of progressively responsible leadership experience in revenue cycle and related operations, including end-to-end revenue cycle management, billing, receivables, credentialing, claims processing, and payer relations within a complex healthcare environment, with at least five years in senior leadership.
- Extensive experience in healthcare industry knowledge, including billing processes, revenue optimization, medical coding, reimbursement methodologies, regulatory compliance, and a proven track record of strategic leadership and successful project management.
PERFORMANCE COMPETENCIES: - Provide oversight of Medicaid managed care implementation, contracting, billing and relationships
- Regulatory, Risk Management, Contract Compliance
KNOWLEDGE/SKILLS/ABILITIES: - Comprehensive knowledge of the entire revenue cycle, including medical coding, reimbursement methodologies, and industry best practices, along with healthcare regulations and compliance standards (ICD-10, CPT, HCPCS, HIPAA, Medicare, Medicaid).
- Proficiency in revenue cycle management software, electronic health records (EHR) systems, billing software, and data analytics, with the ability to leverage technology to enhance revenue cycle processes and ensure compliance with governing regulations and standards.
- Strong analytical, organizational, and project management skills to interpret complex data, oversee operations, and make evidence-based decisions to improve revenue cycle processes and outcomes.
- Proficiency in financial concepts, problem-solving, and multi-tasking, with the ability to identify and resolve issues related to billing, denials, reimbursement, and revenue optimization.
- Exceptional leadership and strategic thinking skills, with the ability to inspire and develop high-performing teams, and execute a comprehensive revenue cycle management strategy aligned with organizational goals.
- Excellent communication and collaboration skills, with expertise in change management and decision-making to drive process improvements and operational efficiency across various departments.
CERTIFICATIONS/LICENSES: - Certified Professional Biller (CPB), Certified Revenue Cycle Professional (CRCP), or Healthcare Financial Management Association certification is a plus.
- Must possess a valid Driver License and satisfactory driving record and use personal automobile to travel to locations other than primary office. Proof of automobile insurance required.
SAFETY SENSITIVE JOB CLASSIFICATION: This job is classified as a "safety-sensitive" position as defined by the Oklahoma Medical Marijuana and Patient Protection Act. Due to the "safety-sensitive" classification, an employee in this position would be subject to drug and alcohol testing, including random testing. Marijuana is one of the substances included in the drug panel screening. Possession of a medical marijuana license will not excuse you from the testing process or the consequences of testing positive for marijuana per the Family & Children's Services Drug Free Workplace Policy, including possible revocation of a job offer or dismissal from employment.
ADDITIONAL INFORMATION: - Extensive experience with progressive responsibilites without bachelors degree may be considered if candidate will agree to obtain a bachelors degree
