Executive Director Revenue Cycle

Description

Title: Executive Director Revenue Cycle

Location: Fountain Valley, CA

Department: Physician Billing

Status: Fulltime

Shift: Day

Pay Range*: $180,398 - $248,060/annually

MemorialCare is a nonprofit integrated health system that includes four leading hospitals, award-winning medical groups - consisting of over 200 sites of care, and more than 2,000 physicians throughout Orange and Los Angeles Counties. We are committed to increasing access to patient-centric, affordable, and high-quality healthcare; your personal contributions are integral to MemorialCare's recognition as a market leader and innovator in value-based and other care models.

Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration, and accountability.Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation, and teamwork.

Position Summary

Lead strategy and operations of revenue cycle functions for MCMF (MemorialCare Medical Foundation) and Nautilus, including services provided for MemorialCare Medical Group (MCMG), MemorialCare Specialty Medical (MSMG), and Nautilus independent physicians.

Essential Functions and Responsibilities of the Job

• Lead and manage end-to-end revenue cycle strategy and operations including patient registration and insurance verification (coordinate both functions with Operations), charge capture, coding, billing, claims management, denial resolution, and collections.

• Develop and implement strategic initiatives to improve revenue cycle performance, reduce denials, and enhance cash flow.

• Drive continuous improvement through data analysis, benchmarking, reporting, and adoption of best practices.

• Manage and monitor the execution of key performance indicators (KPIs), including:

o Days in A/R

o Net collection ratio

o Gross collection ratio

o Denial rate

o First-pass resolution rate

o Clean claim rate

o Bad debt rate

o Cost to collect

o Patient collections rate

o Credit balance resolution days

o Patient satisfaction

• Optimize and improve workflows to minimize cycle times, rework, and operating expenses, including automation and artificial intelligence where appropriate. Apply Lean Six Sigma principles and techniques.

• Ensure timely and accurate monthly reporting of KPIs and results to stakeholders and clients.

• Lead and manage a high-performing team of directors, managers, supervisors, and staff.

• Develop and prepare leaders and staff for advancement; ensure continuity of functional performance across personnel changes.

• Develop a culture of learning, growth, achievement, and accountability.

• Ensure compliance with federal, state, and payer regulations, including HIPAA, CMS, and commercial insurance requirements.

• Oversee coding optimization and compliance.

• Collaborate with IT and clinical operations to optimize EHR and practice management systems for revenue cycle efficiency.

• Partner with finance and accounting teams to support accurate financial reporting and forecasting.

• Serve as a liaison with external vendors, payers, and regulatory bodies.

• Collaborate with Nautilus accounting team regarding contract pricing and compliance for existing and new Nautilus clients.

• Coordinate with MCMG operations staff, provide program leadership of medical clinic front office staff related to revenue cycle functions such as registration, eligibility, etc.

• Serves as the primary liaison with Nautilus clients regarding escalated revenue cycle problem resolution. Develops and maintains positive relationships with practices utilizing Nautilus services.

• As invited, participate in MCMF's Executive Management Team (EMT) meetings. Collaborate with other MCMF and MHS leaders in an effective manner.

• Keep abreast of changes in billing and reimbursement issues, new legislative programs, insurance, and regulatory requirements, etc. and ensures appropriate communication with stakeholders. Functions as the subject matter expert for professional billing issues.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare-that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there's more... Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Qualifications

Minimum Requirements

Qualifications/Work Experience:

Minimum 7 years of progressive leadership experience in revenue cycle with a health system or larger medical group

Education/Licensure/Certification:

Bachelor's degree in Business Administration, Healthcare Administration, Finance, or related field required. Master's degree preferred

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