VP, Revenue Strategy & Operations

Description

Job Summary

The Vice President of Revenue Strategy and Operations is an integral part of the Administrative and Revenue Cycle leadership team. They will have oversight and management of all functions of revenue cycle, including management oversight of all business-related functions of patient visits from point of contact to collection of patient service revenue. They will drive sustainable growth through advocacy and engagement with the state, Health Services Cost Review Commission (HSCRC) and Maryland Hospital Association (MHA) to bolster the position of Frederick Health for rate and policy driven initiatives.

This executive leadership role optimizes technology (CRM, EHR), analytics, and processes to improve revenue integrity, compliance, and profitability. They will support and will be responsible for incorporating into job performance, the Frederick Health (FH) mission, vision, core values and customer service philosophy and adheres to the FH Compliance Program, including following all regulatory requirements and the FH Standards of Behavior

Key Responsibilities and

Essential Functions:

• Strategic Planning:Define and execute revenue strategies, including forecasting, pricing, and market expansion.
• Operational Excellence:Optimize revenue cycle management (RCM) workflows, including billing, claims, and financial clearance.
• Technology & Data:Lead CRM/EHR system strategy, leveraging AI and analytics to enhance data accuracy and performance reporting.
• Cross-functional Leadership:Align senior leadership and service lines to ensure consistent, scalable revenue processes.
• Compliance & Risk:Ensure adherence to healthcare regulations (HIPAA, payer policies) and optimize audit readiness.
  • Collaborates with managers and team members to ensure maximization of revenue and cash flow while maintaining the highest levels of patient, physician, and employee engagement.
  • Promotes standardization of business practices, remove barriers to successful operations, and ensure that regulatory requirements and standards are met.

Oversight responsibilities include:

• Rev Cycle Operations - compliance with third party payer regulations and audits, customer service activities, vendor management, employee productivity and ongoing improvements to key revenue cycle indicators.
• Maryland and Federal reimbursement model compliance
• Payor Contracting – rate negotiation and alignment strategies, contract resolution and escalation of payment discrepancies
• Value Based Care Program performance – contract monitoring and analysis, dashboard review with Medical Group and community providers through Frederick Integrated Health Network (FIHN) organization

• HSCRC Rate Management:Ensure rate orders are optimized to realize the full potential of the approved Global Budget while maintaining compliance with state-mandated policies.
• G  Performance Strategy:Develop strategies to maximize G  by reducing potentially avoidable utilization and shifting care to lower-cost settings without losing budget value.
• Market Shift Oversight:Monitor and manage market shift adjustments to ensure revenue is captured or protected when patient volumes move between facilities in the service area.
• Quality & Policy Alignment:Partner with clinical leadership to ensure high performance in HSCRC Quality Programs (e.g., Readmissions, Quality-Based Reimbursement), as these results directly impact the global revenue ceiling.
• Capital Policy Planning:Coordinate large-scale project funding through the HSCRC Capital Policy, ensuring new projects receive appropriate rate updates and meet state efficiency standards.

Required

Knowledge, Skills and Abilities:

• Demonstrated extensive knowledge of third-party and insurance company operating procedures, regulations and billing requirements, and government reimbursement programs.
• Excellent command of medical information systems for billing and accounts receivable, spreadsheets, reporting applications, medical terminology, coding and office procedures. Adds value to the organization through proactive analysis of and resolution to potential bottlenecks that may negatively affect the organization’s…