Senior Director, Revenue Cycle Management

1 month ago

San Francisco, United States Element Science Full time

SENIOR DIRECTOR, REVENUE CYCLE MANAGEMENT


THE COMPANY:


Element Science, Inc. is a medical device and digital health company focused on developing solutions at the intersection of clinical-grade wearables, machine learning algorithms, and lifesaving therapies in order to address leading causes of death and hospitalization in patients with heart disease, primarily as they transition from the hospital-to-home. By putting the needs of patients and physicians first, our personalized digital devices, which are designed for function, comfort, and ease-of-use, aim to redefine the paradigm of care for these patients. Our first product, a wearable patch defibrillator, is initially targeted at treating the more than 500,000 patients in the US with an elevated temporary risk of potentially experiencing a lethal heart rhythm. Based in San Francisco, our funders include Third Rock Ventures, Google Ventures, Deerfield Healthcare, Qiming Venture Partners USA, Cormorant Asset Management, and Invus Opportunities.


SUMMARY OF ROLE:


As the Senior Director of Revenue Cycle Management, you will lead our RCM operations, setting comprehensive reimbursement strategic direction, implementing systems, driving the execution of revenue cycle processes and compliance with all healthcare regulations to optimize financial outcomes. The successful candidate will be a seasoned professional with a deep understanding of the healthcare billing ecosystem, reimbursement policies, healthcare regulations, and billing practices related to durable medical equipment.


RESPONSIBILITIES:


As the first person to hold this title, you have a unique opportunity to define the metrics, take process from zero to one, and build our Revenue Cycle function from the ground up. We have significant traction, and you will play a pivotal role in creating much of the foundation of our billing policies, RCM best practices, and KPI management as we continue to scale. Your work will span across all dimensions of RCM. The ideal candidate will come in and accomplish the following:


  • Define relevant KPIs and metrics as they relate to RCM, set targets for these metrics, and identify levers to achieve our targets.

Reimbursement Strategy Development:


  • Develop and execute reimbursement strategies to optimize revenue cycle management and ensure compliance with regulatory requirements, including assessment of build vs outsourcing strategies.
  • Stay abreast of changes in healthcare reimbursement policies and proactively adjust strategies to align with industry trends.

Billing Process Development & Management:


  • Implement best practices for billing operations, system implementations, and continually assess and improve processes.
  • Oversee end-to-end RCM related functions including intake, eligibility, prior authorization, medical necessity documentation, billing, cash applications, collections, denial appeals, and reporting & analysis ensuring accuracy, efficiency, and compliance with relevant regulations.
  • Eligibility: Utilize claims data to manage our eligibility software tool and/or vendor to improve accuracy of eligibility and benefit estimates and optimize prior authorization process for patients.
  • Billing: Oversee in-house resources & billing tools and/or third-party vendor to ensure accurate coding and submission of claims; improve claim submission process to increase automation, first pass rates, and collections.
  • Collections: Manage in-house and/or 3rd party billing vendor and ensure they are meeting SLAs and targets; monitor and analyze collections data to identify opportunities for improvements and when relevant, implement strategy and process changes to drive improvements.
  • Manage patient advocacy process.

Regulatory Compliance:


  • Stay current on federal and state regulations related to reimbursement and billing for durable medical equipment.
  • Work closely with legal and compliance teams to ensure adherence to all applicable laws and guidelines.

Cross-Functional Collaboration:


  • Partner with Payer Relations and Market Access team and IT team to implement reimbursement processing steps such as EDI submissions as CMS and each Payer are contracted.
  • Collaborate with Sales, Marketing, and Product Development teams to provide insights into reimbursement trends and contribute to product development strategies.
  • Partner with Finance to analyze reimbursement impacts on financial performance and support budgeting processes.

Team Leadership:


  • Build and lead a high-performing reimbursement and billing team.
  • Provide mentorship, guidance, and professional development opportunities for team members.

QUALIFICATIONS:


  • Bachelor's degree in healthcare administration, business, or related field; Master's degree preferred.
  • Minimum of 15 years of experience in healthcare reimbursement and billing, with at least 7 years in a leadership role.
  • In-depth knowledge of Medicare, Medicaid, and commercial payer reimbursement policies for durable medical equipment.
  • Strong understanding of healthcare compliance and regulatory requirements.
  • Proven ability to develop and implement successful reimbursement strategies, processes, and systems.
  • Excellent leadership, communication, and interpersonal skills.

BENEFITS:


Element Science offers a very competitive salary and benefits package including, but not limited to:


  • Stock Options
  • 90% employer-paid medical, dental, and vision insurance
  • Company-paid Basic Life Insurance
  • 401(k) retirement plan (Traditional and Roth)
  • Competitive Paid Time Off
  • Paid Holidays
  • FSA (Flexible Spending Accounts)
  • HSA (Health Savings Account)
  • Employee Assistance Program through PEO

The salary for this exempt-level position will be based on experience and qualifications within an established pay range.


Element Science is an Equal Opportunity Employer. All candidates will be evaluated on the basis of their qualifications for the job in question. We do not base our employment decision on an employee's or applicant's race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, or other non-merit-based factors prohibited by local, state, or federal law.


In compliance with federal law, all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification form upon hire. We are not able to sponsor individuals for employment visas for this job.


At this time, we are unable to offer relocation assistance at Element Science.

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