Executive Director of Revenue Cycle

3 weeks ago

Durham, United States EmergeOrtho Full time
Description

This position is hybrid eligible, with onsite and remote work accommodations. Candidate must reside in one of our regions in North Carolina.

EmergeOrtho is committed to being the trusted leader in innovative, quality-focused comprehensive musculoskeletal care. With offices across North Carolina, the Executive Director of Revenue Cycle is responsible for developing and executing the strategic vision for the revenue cycle functions to improve overall operational effectiveness, provide leadership and oversight of key operational and financial decisions pertaining to all back-end revenue cycle operations. This leadership role is responsible for managing all aspects of the corporate revenue cycle physician-based billing, reporting, and managed care relationships. This position requires a strong blend of strategic thinking, operational excellence, and team leadership skills to ensure accurate and timely billing operations while maintaining a high level of customer satisfaction. This role provides leadership to staff and ensures all functions and staff follow applicable policies and procedures, quality standards, contractual obligations and applicable laws and regulations. Interacts with clinical and business leaders across the organization to ensure optimal financial and patient experience results.

Requirements

Qualifications and Experience:
  • Seven (7) years of progressive leadership experience in large healthcare organizations, payor organizations, and/or integrated healthcare delivery systems.
  • Seven (7) years of experience in strategy management of healthcare billing, reimbursement, pricing, contract negotiation and healthcare economics in a complex, multi-regional healthcare practice/system or health insurance environment.
  • Demonstrated track record of leading fee for service, value-based, and alternative payment model strategies.
  • Demonstrated success in leading, implementing, reporting and managing financial performance of payor contracts.
  • Revenue Cycle operations experience including knowledge in pre-authorization, preadmission processes, denials management, claims adjudication, etc.
  • Revenue Cycle business process optimization experience including knowledge of edits, denials, holds, reimbursement, refunds, etc.
  • Knowledge of various types of health insurance and other third-party reimbursement, health care billing practices, automated billing and accounting systems, collection laws and techniques on working with patients' ability to meet payment obligation.
  • Demonstrated ability to work effectively and to have effectively driven strategic transformation work.
  • B.S. in Business Administration or related clinical field. Master's prepared with an MBA or MHA strongly preferred.
Demonstrated success in the following:
  • Ability to exercise a high degree of initiative, judgment, discretion, and decision-making to achieve organization's mission.
  • Analyzing situations accurately and taking effective action.
  • Responsible for the provider-based entity revenue cycle accounts receivable including strategic and tactical recoveries.
  • Establishes standards and processes to ensure continuous improvement in the revenue cycle by developing and implementing changes & enhancements timely and strategically driving transformation.
  • Responsible for denial management & follow-up and must be effective in implementation of financial improvement strategies that generate recoveries meeting or exceeding recovery goals.
  • Lead the establishment and implementation of KPIs for revenue cycle operations. Responsible for measurement and reporting of ongoing financial and operational performance. Ensure the implementation of action plans where performance is not meeting expectations. Review KPI expectations annually and adjust appropriately. Recognize areas of excellence.
  • Manages relations with payers and providers to generate high reimbursement rates and a low level of denials.
  • Collaborates with others to ensure reconciliation for revenue, cash, contractual allowance, bad debt, write offs, recoveries, un-posted cash, cash deposits, and all other adjustments.
  • Maintains a high-level expertise of healthcare finance, government and commercial reimbursement programs, managed care as well as state and local reimbursement programs. Collaborates with all levels including financial leaders, executive management, and vendors to ensure financial and operational goals are met within a cost-effective, efficient manner.
  • Optimize billing, revenue collection and direct department operations to ensure that financial, quality, and customer service goals are met.
  • Support, oversee and manage the performance and productivity of the staff, utilizing predefined goals while providing appropriate feedback and guidance to the billing/ patient liability and customer service teams.
  • Ensure that activities are in compliance with applicable policies, standard operating procedures, and standardized practices. Such activities may include billing, insurance issues, and referring accounts to external vendors, among others.
  • Provide oversight for vendor activities related to accounts receivable and customer service.
  • Ensure that managers / supervisors provide timely feedback to department staff regarding people's performance, quality, and training requirements including necessary training. Drives a culture that reflects our mission, vision and values.
  • Maintain efficiency in capacity planning, FTE costs management.
  • Serve as subject matter expert for revenue cycle billing functions and actively research and understand latest industry and market trends, leading practices and technologies.
  • Acts as a revenue cycle leader for system conversion, purchases and divestitures.
  • Create a collaborative and conducive work environment for employees & colleagues through team building, coaching, constructive feedback, work delegation, personal example and goal setting that encourages creativity, open dialogue on work issues, professional growth, and a consistent, high level of performance. Encourage and support employee decision-making within their scope of responsibilities.
  • Participate in and, where appropriate, lead cross-functional revenue cycle projects. Engages with senior management and department heads to align operational delivery and financial management with short- & long-term planning and projections.
  • Organizing work, delegating, and achieving goals and objectives.
  • Effective organization and integration of organizational priorities and deadlines
  • Analysis and development of comprehensive measurement reports
  • Effective communication and collaboration among physicians, staff, payor relationships, government officials and the public
  • Knowledge of relevant health care laws and regulations.
  • Exceptional organizational, communication and problem-solving skills.
  • Ability to make decisions quickly if needed; ability to prioritize multiple competing demands.
  • Advanced knowledge of Microsoft Office including Excel and PowerPoint.
Responsibilities include, but are not limited to:
  • Responsible for strategic and operational integration activities of managed care payor strategy across EmergeOrtho, to include oversight of, and collaboration with, the following managed care functions: payor strategy, value-based contracting strategy, contract management and operations, and commercial bundles.
  • Implement and monitor success of payor strategies to drive sustainable financial performance.
  • Develop and maintain enterprise value-based contracting strategies and implementation guardrails that lower total cost of care, improve population health and drive growth & sustainable financial performance.
  • Oversee managed care contract maintenance, access, and operational management processes and activities.
  • Monitor, analyze, and provide strategic insights on CMS reimbursement & payment policy changes impacting managed care contracts & payor strategies.
  • Lead and deliver research, analysis, and payor strategy development activities to support successful strategy execution and merger/acquisition/divestiture transactions.
  • Demonstrate concrete and relevant revenue linkages between payor contracts, value generation to customers, and objectives.
  • Lead and advocate for new innovative products, develop business rationale for Medicare Advantage, and other appropriate opportunities.
  • Maintain professional affiliations and enhance professional development to keep current in the latest health care trends and developments.
  • Prepare agendas, reports, and presentations for committee, board and shareholder meetings; lead discussions and coordinate any subsequent changes.
  • Write and respond to a high volume of emails in a prompt manner; place and retrieve many phone calls daily.

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