Lead Director, Healthcare Revenue Cycle Solutions Specialist

6 days ago

Monroeville, Pennsylvania, United States CVS Health Full time

About This Role

The Director, Revenue Cycle Solutions will play a critical role in driving strategic oversight of Specialty Revenue Cycle Process Improvement, Payer Relations, Reimbursement Analysis, and Training and QA Departments. This position will be responsible for aiding the Revenue Cycle Department in reaching overall department goals through proactive management of the IT budget, successful deployment of prioritized projects, and end-user support.

Key Responsibilities

  • Partner with Process Improvement Leader and Revenue Cycle Leaders to develop and maintain the Revenue Cycle Capital Budget for IT projects, ensuring secured funds are prioritized based on department need and resource availability.
  • Manage assigned projects from inception through implementation, focusing on ensuring delivered product meets expected timelines and achieves associated objectives.
  • Provide end-user support across Specialty Revenue Cycle and system issues, communicating, escalating, and resolving them.
  • Partner with Payer Relations Leader to provide strategic oversight for the department, ensuring timely and accurate creation and maintenance of all insurance plans, pricing fee schedules, edits, and system rules controlled through this department.
  • Ensure proper resource allocation for strategic initiatives requiring maintenance, analysis, and support from the Payer Relations team.
  • Implement thorough controls to monitor quality and timeliness for all entry performed directly by the department or coordinated through IT.
  • Partner with Reimbursement Analysis Leader to provide strategic oversight to the department, completing timely and accurate reimbursement analysis, identifying and building action plans based on issues and trends identified.
  • Prepare and present routine reports on pricing performance, financial impact, and opportunities to senior management and key stakeholders, providing insights and recommendations for strategic decision-making.
  • Partner with Training and QA to ensure the Training and QA teams are partnering with RCM leaders to identify, design, develop, and implement training solutions that meet the learning and performance needs of RCM colleagues.

Requirements

  • 10+ years of related experience
  • 5+ years of healthcare technology experience, preferably in specialty pharmacy
  • 8+ years of progressive leadership experience in healthcare revenue cycle environment with notable increases in responsibility

Preferred Qualifications

  • Proven ability to collaborate across business lines to work towards enterprise goals and objectives.
  • Adept at building consensus with stakeholders regarding strategy, direction, execution, and delivery.
  • Strong leadership skills, strategic mindset, and experience leading highly functioning teams focused on identifying and implementing complex solutions.
  • Ability to participate in development of resource plans and structures and influence organization priorities.
  • Experience with diverse operating systems, including proven technical skills required to support the systems.
  • Understanding of software development methodologies/lifecycle (SDLC) and proven ability to lead complex system projects from requirements through testing and implementation.
  • Ability to interpret and communicate technical information into business language.
  • Strong analytical skills with the ability to interpret financial data, identify trends, and develop actionable insights and strategies.
  • Ability to meet deadlines across multiple workstreams with competing priorities and deliver results that meet or exceed expectations.
  • Excellent verbal, interpersonal, and written communication skills.
  • Ability to evaluate work and process flow to ensure optimal efficiencies.
  • Experience working with revenue cycle applications and healthcare finance and accounting principles.

Education

  • High School Diploma/GED required
  • Bachelor's Degree or higher preferred, relevant experience may be considered in lieu of degree

Pay Range

The typical pay range for this role is $100,000 - $231,500.00. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors, including experience, education, geography, and other relevant factors. This position is eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company's equity award program.

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