VP Revenue Cycle Optimization

POSITION SUMMARY

Primary responsibility for leading and managing all aspects of revenue cycle for the organization, including negotiating with payers, maintaining relationship and monitoring of third-party billing organization and EPIC hosting organization, developing and implementing revenue optimization strategies, regulatory compliance with third-party insurers, and oversight of financial counselors and patient accounts. Develops and maintains billing and reporting systems. Hires, supervises, trains and evaluates staff on the Revenue Cycle, Revenue Optimization and Financial Counselor Teams.

Coordinates credentialing activities.

• Hires and retains a diverse, highly qualified staff and provides ongoing performance feedback and maintains a safe and professional work environment.
• Trains or assists in training staff in other departments on revenue cycle related areas (both administrative and program) as needed.
• Evaluates staff in a timely manner in accordance with PPGNY’s policies.
• Performs other educational and experience related duties as required.

• Performs analysis of revenue cycle trends and identifies areas of focus to reduce denials and increase overall collections.
• Performs root cause analysis for areas identified and proposes solutions to achieve overall enhancement of revenue.
• Works closely with EPIC hosting organization to identify and implement automated solutions.
• Collaborates with third party RCM vendor and health center operations to implement process changes.
• Develop and roll out SOP’s to document process changes.
• Train impacted staff on changes.
• Resolves third-party billing difficulties that are beyond the experience of PPGNY or third-party vendor staff.

• Serves as the organization’s main contact with outsourced RCM vendor to identify, resolve and prevent future issues. This includes setting up metrics to evaluate the RCM vendor’s performance.
• Perform under and over payment audits
• Oversee the PPGNY WQ’s to ensure work is done timely and accurately
• Perform monthly monitoring of key metrics and identify issues driving underperformance
• Develops/maintains procedures for internal control.
• Works closely with other departments on internal and external reporting as it relates to clinical revenue.

• Coordinates the coding audit on a periodic basis conducted by an outside agency, and partners with clinical services leadership to provide training and feedback to the clinical providers on their performance and areas for improvement.
• Acts as primary interface with Medicaid and other third-party billing authorities, working with them to resolve in appropriate denials.
• Actively maintains an up-to-date knowledge base of developments in third-party billing, such as changes in Medicaid reporting requirements. Keeps the CFO, CEO and other appropriate staff informed of same. Modifies department procedures to respond to such developments; and instructs and monitors staff with regard to procedure modifications.

• Works with external managed care consultant in negotiating periodic rate changes and contracting with third party payers.
• Works closely with managed care contracting consultant to maximize reimbursement, including escalating revenue cycle issues that are not consistent with payer contracts.

• Creates and monitors proper reporting tools for analytical review of the performance of the revenue cycle, including accounts receivable, write offs, payment posting, and charge entry.
• Develops reporting tools to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third-party RCM vendor.
• Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance.

• A demonstrated commitment to PPGNY’s mission related to bodily autonomy, health equity, gender and racial justice
• A demonstrated commitment to learning about and enhancing practices related to racial equity and its impact on…