TapestryHealth
VP, Revenue Cycle
TapestryHealth - Chicago, Illinois, United States, 60290
Work at TapestryHealth
Overview
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Overview
We are seeking an experienced, highly organized and detail-oriented VP of Revenue Cycle to join our healthcare company. The ideal candidate will be responsible for overseeing and coordinating all Revenue Cycle activities with a goal of maximizing reimbursement in a cost-effective manner in compliance with federal, state and payer-specific billing requirements. The VP will oversee the overall policies, objectives, and initiatives of our revenue cycle activities to optimize collections and ensure revenue integrity.
DUTIES AND RESPONSIBILITIES:
Drive Revenue Cycle Performance
Oversee and support the daily operations of all revenue cycle functions, including payer enrollment, billing, follow-up and collections. Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks. Establish and maintain appropriate collections procedures and monitor to ensure they are being followed. Manage updates to fee schedules to maintain fees at levels that maximize reimbursement. Work with Managed Care vendors in identifying any payer relations issues or contracts that need to be renegotiated or negotiated for the first time. Develop scalable process improvements to drive consistency and accuracy in revenue cycle operations while managing current state performance. Lead implementation and future refinements to revenue cycle performance dashboards.
Serve as Revenue Cycle Expert
Work closely with other departments (Operations, Clinical, Information Technology, Compliance and Finance) to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting collections. Assist with the development of budgets and monitoring of department operations to achieve goals within budget. Develop and maintain internal controls in partnership with internal stakeholders to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implementing solutions. In conjunction with other departments, review and enhance insurance verification, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current work flow. Regularly provide Chief Financial Officer and Chief Accounting Officer with revenue cycle status including reports and key performance metrics. Monitor and lead development of public comment responses on CMS proposed physician fee schedule rule updates.
Lead Revenue Cycle Team
Direct the selection, supervision, performance and evaluation of staff. Oversee orientation and continuing education, ensuring that mandatory and relevant training is provided to staff in a timely manner. Set work schedule and direct changes in priorities as needed to assure work is completed in an efficient and timely manner and to improve the department’s performance and service. Establish and maintain departmental policies and procedures. Communicate relevant information to other departments. Establish controls and review mechanisms to ensure procedures are being followed correctly. Recommend policy changes to the Chief Financial Officer. Implement a Quality Assurance program for functions and monitor staff and team performance, making changes, when required, to support accurate billing to payers and patients in a timely manner and compliance with laws and department procedures. Establish departmental key performance indicators and monitor performance. Facilitate regularly scheduled revenue cycle meeting cadence to discuss strategies, review key performance indicators and ensure everyone is educated on the direction of the department.
Maintain Accountability for Relationship with Billing Company
Ensure that all aspects of the revenue cycle workflow function appropriately. In partnership with billing company and internal stakeholders develop, redesign, and monitor key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters. Ensure that daily production of claims, denials workflows, and appeals processes are functioning as expected. Review results with billing company partners on weekly basis and prioritize efforts as appropriate to drive performance.
In partnership with Chief Compliance Officer, ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers. Serve as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Maintain extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers. Oversee internal and external claims audit activities; coordinate with compliance and other departments as needed. All other relevant duties as assigned to support revenue cycle. QUALIFICATIONS AND EDUCATION REQUIREMENTS:
Associate or bachelor’s degree in healthcare administration, Business, Accounting, Finance or related field. Five years of management-level experience in revenue cycle. Experience/knowledge of Skilled Nursing facilities preferred. Thorough knowledge of physician revenue cycle processes and standards related to credentialing, billing, coding, and collections. General knowledge of patient demographics, finance, and data processing. Knowledge of regulatory requirements related to patient accounting, including a solid understanding of Medicare, Medicaid, and managed care processes. Ability to work and communicate effectively in a fast-paced environment with a diverse group of people including other department leaders, staff, physicians, patients, and external business partners. Ability to read, analyze and interpret financial reports, contracts, and other legal documents. Outstanding ability to work independently to achieve results. Often, there is no precedent for and little help in carrying out assigned tasks. Must originate, plan, adapt, and invent to accomplish tasks. Ability to set and maintain priorities when dealing with multiple demands and interruptions. Strong analytical and problem-solving skills. Dedication to the development of others and willingness to coach and mentor people as necessary to promote their personal and professional growth.
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Oversee and support the daily operations of all revenue cycle functions, including payer enrollment, billing, follow-up and collections. Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks. Establish and maintain appropriate collections procedures and monitor to ensure they are being followed. Manage updates to fee schedules to maintain fees at levels that maximize reimbursement. Work with Managed Care vendors in identifying any payer relations issues or contracts that need to be renegotiated or negotiated for the first time. Develop scalable process improvements to drive consistency and accuracy in revenue cycle operations while managing current state performance. Lead implementation and future refinements to revenue cycle performance dashboards.
Serve as Revenue Cycle Expert
Work closely with other departments (Operations, Clinical, Information Technology, Compliance and Finance) to streamline procedures that will help ensure correct billing to patients and payers in a timely manner, thereby expediting collections. Assist with the development of budgets and monitoring of department operations to achieve goals within budget. Develop and maintain internal controls in partnership with internal stakeholders to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then recommending/implementing solutions. In conjunction with other departments, review and enhance insurance verification, coding review, billing, collection, and payment posting processes for efficiency and best practices; ensure systems are fully functional and maximized and recommend new processes to improve current work flow. Regularly provide Chief Financial Officer and Chief Accounting Officer with revenue cycle status including reports and key performance metrics. Monitor and lead development of public comment responses on CMS proposed physician fee schedule rule updates.
Lead Revenue Cycle Team
Direct the selection, supervision, performance and evaluation of staff. Oversee orientation and continuing education, ensuring that mandatory and relevant training is provided to staff in a timely manner. Set work schedule and direct changes in priorities as needed to assure work is completed in an efficient and timely manner and to improve the department’s performance and service. Establish and maintain departmental policies and procedures. Communicate relevant information to other departments. Establish controls and review mechanisms to ensure procedures are being followed correctly. Recommend policy changes to the Chief Financial Officer. Implement a Quality Assurance program for functions and monitor staff and team performance, making changes, when required, to support accurate billing to payers and patients in a timely manner and compliance with laws and department procedures. Establish departmental key performance indicators and monitor performance. Facilitate regularly scheduled revenue cycle meeting cadence to discuss strategies, review key performance indicators and ensure everyone is educated on the direction of the department.
Maintain Accountability for Relationship with Billing Company
Ensure that all aspects of the revenue cycle workflow function appropriately. In partnership with billing company and internal stakeholders develop, redesign, and monitor key performance indicators including payer mix, A/R, collection rates, adjustments, bad debt write off, estimated collections, appeal success rates, and other requested parameters. Ensure that daily production of claims, denials workflows, and appeals processes are functioning as expected. Review results with billing company partners on weekly basis and prioritize efforts as appropriate to drive performance.
In partnership with Chief Compliance Officer, ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers. Serve as the subject-matter expert on regulatory, compliance, and legal requirements associated with medical billing and CMS. Maintain extensive knowledge of revenue cycle and regulatory requirements associated with governmental, managed care, and commercial payers. Oversee internal and external claims audit activities; coordinate with compliance and other departments as needed. All other relevant duties as assigned to support revenue cycle. QUALIFICATIONS AND EDUCATION REQUIREMENTS:
Associate or bachelor’s degree in healthcare administration, Business, Accounting, Finance or related field. Five years of management-level experience in revenue cycle. Experience/knowledge of Skilled Nursing facilities preferred. Thorough knowledge of physician revenue cycle processes and standards related to credentialing, billing, coding, and collections. General knowledge of patient demographics, finance, and data processing. Knowledge of regulatory requirements related to patient accounting, including a solid understanding of Medicare, Medicaid, and managed care processes. Ability to work and communicate effectively in a fast-paced environment with a diverse group of people including other department leaders, staff, physicians, patients, and external business partners. Ability to read, analyze and interpret financial reports, contracts, and other legal documents. Outstanding ability to work independently to achieve results. Often, there is no precedent for and little help in carrying out assigned tasks. Must originate, plan, adapt, and invent to accomplish tasks. Ability to set and maintain priorities when dealing with multiple demands and interruptions. Strong analytical and problem-solving skills. Dedication to the development of others and willingness to coach and mentor people as necessary to promote their personal and professional growth.
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