Pailin Group Executive Search
National Director of Revenue Cycle Optimization
Req No 2017-6424
- The National Director, Revenue Cycle Optimization provides vision, strategic direction and leadership for end-to-end revenue cycle capabilities that support the long-term objectives, mission and vision of the Organization. Responsibilities include implementing the 2016 Strategic Optimization Plan and developing an excellent revenue cycle team capable of innovating and continuously improving an enterprise-wide, customer-friendly financial experience. Revenue cycle is defined as all administrative functions that contribute to recognition, management, and collection of patient service revenue in all organizational care settings. The position leads through a cross department organizational structure that shares leadership with regional leaders (including clinical) and works to unify the entire organization. As one of the primary areas of focus for member financial interactions, this position plays a key role in defining, delivering and enhancing the consumer financial experience with the Organization
This National Director reports to the Vice President of the Department of Medicine Operations and is a member of the Department of Medicine leadership team. The leader delivers the message of change across the organization and works collaboratively with other leaders within the Organization to build the required competencies and revenue cycle leadership capabilities across the company. The leader will have the ability to shape a vision that builds on the Organization’s unique history and strengths to design a future revenue cycle model exceeding the industry standards for service, timeliness, efficiency and accuracy. This person will collaborate with leaders at all levels of the organization and manage a team of professionals who are accountable for the delivery of a comprehensive revenue cycle for the company. He/she looks ahead 2 to 5 years to ensure that Organization is prepared to accomplish its mission and deliver superior customer services within a rapidly changing healthcare environment.
This leader will manage and maintain priority issues for escalation to the Vice President of Operations, as appropriate. He/she will build a high performance team driving operational excellence in key performance metrics, and will optimize patient service revenues. This leader will have an important role in assuring compliance with internal policies and all State and Federal regulations. They will also lead in innovating to ensure the experience of members and patients is best in the industry, easy to use and understand and brand enhancing.
Essential Duties and Responsibilities
- Provide overall vision, direction and goals for the revenue cycle leadership team made up of Senior Vice Presidents, Chief of Medicine, CFO, directors and managers.
- Ensure that the overall revenue cycle strategy aligns with and supports the Organization’s business objectives and annual Strategic Optimization Plan.
- Lead through the enterprise consumer focus initiatives as a member of key initiatives to improve the enterprise wide Client Service Experience (CSE)
- Develop a high performance national and regional team as measured through the achievement of benchmark process outcomes, audit and compliance results, financial goals and employee satisfaction. Build leadership and management talent throughout the revenue cycle operation. Ensure transparency on goals and performance improvement throughout the revenue cycle process.
- Develop and implements a strategic and operational plan for revenue cycle that addresses financial performance, customer service, IT, human resources, and regulatory requirements.
- Responsibilities include coordinating and leading performance improvement initiatives within the Department of Medicine using Lean, Six Sigma or other tools as required.
- Responsible for all third party vendor medical claim payment processes, relationships, interfaces and metric development. Including, but not limited to, required interfaces for financial, quality measurements and performance measurements.
- Lead revenue cycle integration for organizational expansion and acquisition. Ensure coordination with business development and Department of Medicine for expansion and acquisition plans. Including staffing requirements and evaluation of volume impacts related to future expansion initiatives.
- Oversee professional fee revenue cycle operations for the Organization from point of entry to accurate adjudication of patient’s account.
- Provides revenue cycle subject matter expertise to complement the technical system implementation, including system workflow requirements and design.
- Monitors timeliness and effectiveness of departmental activities, ensuring that accounts receivable is within industry and/or standards.
- Is responsible for oversight of the practice management system, claims edit, and electronic payment transmission information system master tables, in conjunction with the information services department.
- Actively identifies and sponsors system enhancement opportunities and directs new system implementations to ensure that business processes are positively impacted.
- Ensures the accuracy and integrity of the practice management system relative to regulatory requirements, such as Medicare Fraud Initiatives.
- Is responsible for ensuring all professional fee revenue cycle policies, procedures, and standards are appropriate, efficient, compliant, and updated in a timely manner.
- Plans, directs, and evaluates the work of staff; complies with human resources management regulations; ensures adequate staffing levels; makes employment decisions, establishes performance standards, and evaluates employee performance; educates, guides, counsels, and develops staff; and addresses performance management concerns.
- Ensures oversight of agencies contracted to assist with any component of professional billing and collections, including establishment of standardized policies and service level agreements, and monitoring of performance against contractual terms.
- Ensures that all revenue cycle activities are fully documented in accordance with the standards and practices of the organization.
- Oversees compilation of various status reports for management in order to analyze trends and make recommendations.
- Develops budgetary plans, programs, and guidelines to ensure the team’s strict adherence to financial guidelines and requirements.
- Ensures that operating expenses are well within the prescribed limits of budget plans and fiscal guidelines.
- Travels within and outside of California as necessary.
- Additional duties may be assigned.
Participation in Meetings/Committees
- Weekly Department of Operations Staff Meetings.
- Regional Medical Director Meetings.
- Monthly Performance Meetings.
- Joint Operations Meetings
- Any meetings as assigned.
The Revenue Cycle Optimization National Director is responsible for employees in the centralized revenue cycle department, third party revenue vendor relationships and carries out supervisory responsibilities in accordance with Organization’s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints; and resolving problems. Conduct work; appraising performance; rewarding and disciplining employees; addressing complaints; and resolving problems.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Other Skills and Abilities
- Twelve (12) years of experience in leadership, consulting, project management, and/or general management experience in provider-based revenue cycle management.
- A combination of healthcare experience in a health plan, managed care organization, medical group and hospital setting preferred.
- Experience in leading successful large-scale business transformation initiatives.
- Bachelor’s degree in in business, health or public administration, management or a related field preferred.
- Certification in revenue cycle from HFMA highly desired (including CRCR, CMCP, and/or FHFMA) and/or CPC/CPPM certifications.
- Specific training in quality improvement (e.g. Six Sigma) a plus.
- Business expertise, financial acumen and interpersonal skills to effectively work through a matrixed, complex and political organization to influence and facilitate sustainable change.
- Advanced interpersonal communication skills (written and verbal) to deal effectively in delicate, sensitive and/or complex situations with a wide variety of influential internal and external parties.
- Demonstrated experience in professional fee revenue cycle management.
- Strong managerial competencies in the areas of leadership and team development, managerial coaching and mentoring, and a proven track record of building and developing high-performing teams.
- Proven ability to perform functional assessments of departmental processes, recommend improvements, and implement operational changes in policies and procedures.
- Demonstrated experience in current multispecialty CPT and ICD-9/10 coding principles and practices in an ambulatory and inpatient environment.
- Strong analytical skills and adeptness in interpreting strategic vision into an operational model.
- Proven ability to interact with physicians and support staff.
- Proven ability to manage staff.
- Proven ability to manage external vendors.
- Strong written and verbal communication skills.
- Expert knowledge and experience with Centricity Practice Solutions and/or other electronic billing applications and analytics software is essential. Experience must include work flow design and operationalization of future state work flow.
- Proficiency in Microsoft Office applications, including Outlook, Word and Excel.
- Demonstrated knowledge of Medicare, Medicaid, and third-party billing requirements.
- Proven experience with California and Florida payers preferred.
Education and/or Experience
Bachelor’s degree (B.A.) in business, health or public administration, management or related field from 4-year College or university. Master’s degree in hospital or business administration, accounting, finance or related field required. Minimum of twelve (12) years of experience in revenue cycle management positions supporting professional fee billing for large group practices across multiple locations. Experience should include working with Medicaid, commercial/contract payors, capitated health plans, and grant-sponsored sources of funding.
Well-qualified professionals please forward CV/Resume along with compensation requirements in complete confidence to
Health Care Division Group Manager
Pailin Group Professional Search Consultants
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