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VP, Coding, Billing, Compliance

2 months ago

Phoenix, United States Center for Orthopedic and Research Excel Full time
Job DescriptionJob Description

Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.

HOPCo is the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists.

As HOPCo continues to grow, we are looking for a VP, Coding, Billing and Compliance in our Corporate Headquarters. Please see below for the functions and requirements for this position.

ESSENTIAL FUNCTIONS

  • Develop strategic plans and programs for the Revenue Cycle team and ensure objectives of the team are properly defined, implemented, and clearly monitored.
  • Establish communication mechanism for providers to provide continuous education, feedback on documentation performance, and alignment with guidelines and recommendations.
  • Develop policies procedures and plans while ensuring consistent implementation.
  • Ensure that operating expenses are well within the prescribed limits of budget plans and fiscal guidelines.
  • Provide projections and reports as required, for development and management of budgets; produce and analyze monthly reports that assist in the forecast process.
  • Monitor timeliness and effectiveness of department activities, ensuring that posted charges, suspended claims, coding denial percentages are within target.
  • Monitor effectiveness of charge entry and coding efforts and maintain charge volumes are current and within the established time frame specified in the department policy.
  • Enhance work-flow processes throughout the revenue cycle to assist in achieving consistency in maintaining the critical success factors.
  • Ensure effectiveness in maximizing utilization of both asset and people resources.
  • Ensure that Revenue Cycle Coding and Billing processes are controlled through Performance Metrics and Standards.
  • Review the performance of the team on a regular basis to ensure metrics and standards are well within pre-established goals and objectives.
  • Consolidate performance standard reports to monitor progress of initiatives.
  • Design and develop the appropriate organization structure for the Revenue Cycle Coding and Billing team and staff accordingly.
  • Conduct regular meetings with the team, to ensure that implementation of Revenue Cycle Coding and Billing plans, programs and projects strictly adhering to prescribed deadlines and schedules.
  • Participates in the HOPCo Quality and Compliance Workgroup
  • Provides proactive leadership and vision that improves individual development of assigned staff (those in a reporting relationship) through effective selection, orientation, performance evaluation, interpersonal communication, and coaching.
  • Writes and reviews job descriptions on an ongoing basis for those in a reporting relationship.
  • Creates a vibrant, productive, and engaged culture within assigned areas.
  • Develop team performance measures and review and evaluate team performance regularly and during the annual performance review period.
  • Develop training programs that are relevant to continuous development of staff.
  • Ensure that HIPAA Notices of Privacy Practices is on display, if applicable.
  • Ensure that records are stored securely and handled in compliance with HIPPA privacy and security regulations.
  • The job holder must demonstrate current competencies for job position.
  • Other duties as assigned.

EDUCATION

  • Bachelor's Degree in Healthcare Administration, Business or another related field or equivalent required.
  • Master’s Degree preferred.

EXPERIENCE

  • Minimum 10 year of experience in revenue cycle management, with 5-7 years in a Director or equivalent leadership position in medical coding and billing enterprises.
  • Experience working with senior level management to establish a vision, optimize processes, deliver quality billing and collection services, manage cash collections, deploy technology that enhances outcomes, and ensure support for revenue cycle management. Experience coordinating and collaborating with Finance, Quality, and others to ensure accurate coding and billing reporting and that charge volumes and general ledger system mapping are provided in an accurate and consistent manner.

REQUIREMENTS

  • AAPC Certification

KNOWLEDGE

  • Deep knowledge of revenue cycle management in specialty or private practice billing.
  • Deep knowledge of CPT, HCPCS, and diagnosis coding
  • Professional and Hospital Coding and Billing regulations
  • Demonstrated understanding of healthcare, market dynamics, trends in RCM and impact on physician practice management and HOPCo’s ability to compete and grow.
  • Strong background in financial management with knowledge of complex reimbursement structures and governmental regulations to the billing processes.

SKILLS

  • Strong analytical, problem solving and critical thinking skills to interpret complex revenue cycle metrics/results/plans and strategies into operational plans.
  • Strong interpersonal skills.
  • Strong written and verbal communication skills.
  • Excellent presentation skills, comfortable facilitating discussion amid diverse perspectives.
  • Skills in proactive strategic planning
  • Skills in focused project management, must be a well-organized and self-directed individual.
  • Proven skill in basic revenue cycle operations and building alignment with clinic/ASC/hospital partners.
  • Mentorship; excellent facilitator and adequate conflict resolution skills. Experience in leadership of teams or projects beyond multiple departmental level required.
  • Superior judgement, negotiation, and decision-making skills with a high level of professional integrity.

ABILITIES

  • Ability to ensure the maximization of coding and billing practices while maintaining the highest levels of patients, physicians, employees, and other customer relations.
  • Demonstrated ability to provide proactive analysis of and resolution to potential challenges that may affect the organization’s coding and billing volumes that may impact reimbursement.
  • Ability to use good judgment.
  • Successful track record developing, coaching, and mentoring high performing teams in a technology-enabled business across multiple locations.
  • Demonstrated ability to relate to people at all organizational levels.