Head of Revenue Cycle Management

Position Title:

Head of Revenue Cycle Management (RCM)

FLSA Status:

Exempt

Department/Location:

Corporate

Travel Requirements:

Occasional

Essential Job Functions:

The following essential job functions are those functions which the individual occupying this position must perform. A qualified person with a disability may request a modification or adjustment to the work environment (a reasonable accommodation) which the company will attempt to provide, unless undue hardship would occur.

The Opportunity:

The Head of Revenue Cycle (Director) will serve as the revenue cycle leader for Pain Specialists of America (PSA). The Director will lead a team that will provide clinic-specific reporting on financial performance and partner with regional clinic leadership to create and implement action plans to drive improvement of revenue cycle metrics to enhance financial performance. Responsible for optimizing all VOB, Insurance Data Management, Billing, Cash Application, and Collections, considering business objectives and operating compliantly at all times. The Director will facilitate communication to drive consistent patient experiences and performance.

The position requires a unique blend of customer service, procedural knowledge, technical knowledge, reimbursement knowledge, and managed care focus to work effectively with both internal and external customers. The Director will provide business analysis for critical information requests, process re-engineering, business change management, and metric analysis with respect to Business and People Performance. In addition, the Director will be directly responsible for defining and implementing the Revenue System/Controls roadmap, supporting periodic audit requirements, and developing a culture of rigorous controls to mitigate risk and ensure the existence of sustainable business practices. As a leader, this individual will need to operate as an influential member and partner with Legal, Compliance, Finance, Contracting, Operations, and IT functions, ensure compliance and quality of documentation, support sales and customer service goals, and adapt to changing business priorities as needed.

Primary Responsibilities:

• Management of RCM team, working collaboratively to ensure the compliant, accurate, efficient, and timely coordination of the revenue workflow, implementation of contract strategy, optimized cash collection, and internal/external compliance to executed payer agreements.
• Studies, analyzes and reports on internal and external trends, recommends opportunities to drive functional performance in order to deliver continuously improving financial revenue cycle outcomes and processes.
• Vigilantly assesses for potential risks, exposures, and noncompliant circumstances while owning resolution of identified regulatory issues associated with areas of functional responsibility.
• Responsible for defining, managing to, and optimizing key performance metrics, including but not limited to DSO, Cash Conversion Cycle, Bad Debt, % of Billing/Revenue Collected, Employee productivity and capacity utilization, Denial Rates, Credit Balances, Contract effectiveness, Payer Performance, etc.
• Ensures compliance in all aspects of RCM activities including coding and billing rules and regulations by payer and state. Responsible for monitoring and responding to any legislative/regulatory billing changes. (i.e. ICD-10).
• Delivering Revenue Cycle efficiencies through Employee development, System selection/automation, Process design, Development of Payer Relations, avoiding waste/redundancy, and applying root cause assessment in order to deliver continuous Revenue Cycle improvements.
• Delivering improved Revenue Cycle outcomes through execution of Pricing and Contracting Strategy and consideration of employee performance incentives.
• Establishes and maintains relationships with provider networks and other departments to create effective business partnerships and controls.
• Investigates, initiates, and manages process and cost saving initiatives.
• Participates in planning and execution of programs and strategies.
• Provides guidance, coaching, and performance management across a diverse set of team members. Manages staff to ensure overall service quality and compliance with all relevant internal policies and procedures.
• Follows all regulatory policies and procedures, privacy, and security standards in accordance with government agencies to include including HIPAA requirements.
• Prepares and submits projects and/or reports timely and within budget.
• Revenue Cycle responsibility spanning all existing businesses and supports definition and implementation of Revenue Cycle requirements in association with future businesses.
• Operates as a contributing member of the executive team and drives for results as a business leader.
• Ensures Revenue Cycle goals are aligned, at all times, with overall business goals and objectives.
• Ensures internal controls are sound and effective to ensure compliance with the Sarbanes-Oxley Act ("SOX") and Contributes to the establishment of SOX compliance for the business and is responsible for ensuring the implementation of that assessment.
• Partners with Finance on establishing quarterly cash collection and DSO targets.
• Works collaboratively with senior leadership to ensure that company goals are met.

Supervisory Responsibilities:

• Ability to lead, manage and motivate a multi-functional team.
• Ability to lead teams to ensure departmental goals and objectives are achieved and exceeded.
• Maintains a culture of accountability by setting clear objectives for all employees in areas of responsibility through regular follow-up, variance tracking, and results.
• Ensures existence of challenging yet achievable goals across his/her functional area and aligned with key stakeholders and with the business’ strategic goals and objectives.
• Conducts accurate and timely assessment of subordinates through annual performance reviews.
• Conducts supervisory responsibilities in accordance with the organization’s policies and applicable labor laws.

Requirements:

• Bachelor’s Degree (four-year college or university) in applicable course of study (Finance, Management, Accounting, etc. preferred.
• Certification or credential in coding and/or billing, such as Health Information Management (HIM), Registered Health Information Administrator (RHIA), or Registered Health Information Technician (RHIT) or equivalent healthcare coding and/or billing experience preferred.
• A minimum of 5 years related experience managing remote teams. Prior experience leading an RCM team strongly preferred.
• Previous healthcare experience required.
• Experience applying knowledge of medical insurance billing and collections, Medicare, Medicaid, managed care including ICD-10 codes and modifiers and terminology associated healthcare compliance standards.
• Experience applying knowledge in collecting, analyzing, and reporting revenue cycle management data used to identify opportunities and strategies for improvement.
• System assessment, implementation, and change control experience in a Revenue Cycle setting.
• Advanced knowledge of Microsoft Excel and Word.
• Expertise in using Great Plains, NetSuite, or similar financial application reporting suite.
• Hands-on, detail driven with strong analytic skills.
• Excellent written and oral communication skills. The Director must write effectively and be able to present positions both through oral presentations and written reports.
• Understands and values the importance of the “team” in accomplishing goals.
• Must be able to work in a dynamic environment.
• Must be a self-starter, be able to take the initiative and deliver ahead of schedule.