The Executive Director, Revenue Cycle Management is responsible for the work processes, management, metrics and overall development and optimization of the physician-based revenue cycle for CKHN. Develops, maintains and seeks to enhance the business standards and expectations of the revenue cycle work performed within the department. Responsible for a multitude of functions within the revenue cycle as well as building work relationships with individuals and teams within the CKHN practices, CKHN Central Billing Office (CBO) and CKHN Operations. Looks for innovative solutions to existing issues to maximize revenue while ensuring compliance with all applicable laws and regulations.
Areas of direct responsibility include training, payor enrollment, practice support, reporting/analytics and all associated teams that comprise the billing and collections functions for CKHN. Collaborates with CKHN Finance, Prospect Physician Enterprise (PPE) and others to identify and communicate barriers or gaps in the revenue cycle continuum and to mitigate issues involving negative cash flow in a timely and effective manner. Manages, directs and coordinates activities of the CKHN CBO Leadership Team with overall responsibility for developing, promoting and executing a vision the achieves top quartile billing results. Acts as a change agent through process improvement opportunities, leadership and strategic vision.
As a member of the CKHN Senior Management Team, works collaboratively and effectively with all members of leadership to ensure that CKHN Revenue Cycle functions efficiently, effectively and to best practice and industry standards
Works with the CKHN Finance Team and PPE to provide information required for Corporate Financial Reporting, budgeting and any analysis required.
Provides detailed, meaningful and credible reports and analysis about CKHN revenue cycle performance on a routine basis and in formats that are understandable to all parties. As required/requested, presents pertinent information, analysis and recommendations for improvement to senior leadership.
Maximizes department revenue by implementing and managing strategies to enhance collections (insurance and guarantor).
Creates or assists with business plans, projects, proposals and internal/external communication as necessary and required.
Effectively manages department expenses against budget and within industry standards. Recommends and implements changes that reduces the cost to collect without sacrificing patient relations or revenue.
Ensures all department policies and procedures are comprehensive and meaningful. Reviews all policies and procedures annually for accuracy and applicability.
Provides leadership, coaching and overall performance management to assigned direct reports.
Conducts frequent one on one meetings with individual direct reports to discuss team issues, operational challenges/barriers and professional coaching and development.
Shows direct and tangible evidence of coaching, mentoring and development of direct reports to be more independent, risk taking individuals.
Conducts CBO Leadership Team staff meetings to ensure effective team communication and full integration of workflow, processes and results among the teams.
Prepares well thought-out and meaningful performance appraisals for direct reports. Provides tangible evidence of work performance/behaviors. Uses the appraisal tool and other opportunities to both summarize performance as well as focus on opportunities for improvement.
Performance manages direct reports to improve performance.
Continually monitors all KPIs/metrics within the entire revenue cycle continuum to ensure optimal performance and results. Acts quickly and decisively when issues arise that result in gaps in process or unexpected lags. Communicates issues as needed and escalates as appropriate.
Effectively works to identify charge edits and denials (errors) caused by antiquated front-end processes, training gaps, system issues or human error and works to communicate such errors in a manner to drive greater quality in the revenue cycle and improved outcomes.
Collaborates with CKHN Finance and PPE in preparing annual operating budgets.
For aspects of the CKHN revenue cycle that are outsourced to third party organizations, works effectively to build and maintain productive and meaningful relationships. Actively promotes the needs of CKHN revenue cycle and monitors vendor performance to ensure expected results. Escalates issues as required.
Promotes and monitors effective communication and collaboration among all CKHN employees who have roles to play in the CKHN Revenue Cycle. Intervenes as required to resolve issues adversely affecting the ability of CKHN to collect revenue.
Provides response as requested on any issues raised by the Senior Management of CKHN, CKHS or PPE.
Works to enhance revenue cycle training among all involved parties to help drive ownership and accountability to CKHN standards and expectations.
Works with the CKHS Coding Department, and the CKHS Compliance Office to ensure that all services billed by CKHN are compliant in all matters related to federal and state regulations.
Collaborates in response to compliance audits and inquiries.
Maintain a working knowledge of the healthcare business environment to provide input and assistance in obtaining all available revenue resulting from various and diverse offerings from all insurance carriers or government agencies.
Perform other duties as assigned.
Education and Training:
Minimum 10 years experience in progressively responsible management positions supporting multi-specialty physician group billing
Demonstrated leadership and management experience.
Specific knowledge of third-party billing claims processing procedures including Medicare/Medicaid requirements.
Demonstrated knowledge and improvements in all aspects of the revenue cycle continuum.
General knowledge of insurance company procedures and the dynamics of the healthcare industry.
Proven experience in leading long-term complex projects to successful conclusions.
Effective third-party vendor management a plus.
Ability to communicate and work effectively with all levels of management, clinicians, support staff and patients.
Strong financial acumen
Excellent verbal, written and analytical skills
Effective and decisive under pressure
Ability to multi-task
Proficiency with Microsoft Office software
Prospect Medical Holdings