Group Executive: (VP) Professional Fee Revenue Cycle

Job Purpose

The Group Executive of Revenue Cycle is accountable for overseeing the end-to-end revenue cycle for Relias Healthcare, ensuring a sustainable and scalable model for financial performance and revenue growth. This executive role aims to maximize cash flow, maintain revenue integrity, and guide strategic direction for all revenue cycle operations while enhancing stakeholder relationships and internal efficiencies.

Key Responsibilities

Understanding our mission, vision, and values, the Group Executive of Revenue Cycle will:

1. People (Every decision should be filtered through the lens of our people)

• Decision-Making through the People Lens: Ensure all decisions prioritize providers as the top priority, hospitals as partners, and patients as our purpose.
• Cross-Departmental Collaboration: Collaborate with medical directors, site administrators, and the executive team to support provider communication, documentation, and quality assurance across the revenue cycle.
• Team Development: Mentor and develop RCM team members, including CDI (Clinical Documentation Improvement) staff and RCM vendor partners, ensuring optimal resource allocation and performance.
• Stakeholder Communication: Regularly report revenue cycle performance to internal stakeholders, including weekly updates to the CEO, CFO, and CMO, to ensure transparency and strategic alignment.

2. Innovation (Always asking- What’s Next?)

• Technology and Process Innovation: Identify and implement advanced RCM technologies (e.g., predictive analytics, automated billing processes) and innovative methods to improve revenue capture and reduce cycle times.
• Continuous Improvement Initiatives: Launch quarterly initiatives or charter projects to assess and incorporate industry advancements that enhance revenue cycle efficiency and customer experience.
• Data-Driven Decision Making: Utilize data analytics tools to track and forecast revenue cycle performance, optimize workflow, and predict trends to ensure proactive RCM operations.
• Industry Trends: Monitor industry regulations and participate in forums and organizations (ACEP, MGMA, EDPMA) to stay current on changes impacting revenue cycle management and compliance.
• Go-Live with New Facility RCM Stand-Up: Oversee the launch of new RCM setups in facilities, including vendor selection, CPVs, EMR integration, testing, and payer contracting.

3. Quality (Only Producing Strong Work)

• Revenue Cycle Integrity: Oversee clean claims submission, timely AR follow-up, and denial management, achieving measurable improvements in claims accuracy and compliance rates.
• Auditing and Compliance: Ensure bi-annual independent coding and billing audits, verify quality checks on patient logs, and ensure compliance with internal policies and regulations (e.g., MIPS, MACRA, No Surprises Act).
• Provider Documentation: Develop ongoing provider education and quality assurance, including one-on-one sessions and regular documentation audits, to improve coding accuracy and reduce revenue leakage.
• Vendor Accountability: Oversee RCM vendors, ensuring they meet performance benchmarks such as days in AR, denial rates, and clean claims percentages. Coordinate quarterly reviews to assess compliance and alignment with Relias’s standards.
• Charting Accountability, Training, and Education: Foster accountability in charting through regular training and education initiatives to enhance accuracy and compliance.

4. Value (Be good stewards of our Finances)

· Financial Stewardship: Develop and implement standard policies for write-offs, discounts, and adjustments, ensuring minimal deviation and maintaining revenue integrity.

· Cost-Efficiency Initiatives: Lead efforts to reduce cost-to-collect by optimizing vendor partnerships, in-sourcing where feasible, and implementing best practices to streamline RCM functions.

· Payer Contracting and Negotiation: Oversee payer contracting strategies, aiming for master agreements to minimize credentialing costs and ensure favorable rates, especially in consolidated payer markets.

· Revenue Analysis and Reporting: Generate weekly and monthly revenue reports and metrics to analyze outliers and adjust strategies. Support site administrators in achieving revenue targets through proformas and bio requests.

5. Excellence Always being a step ahead of our stakeholders and holding our organization to the highest standards.

· Setting the Standard for Stakeholder Engagement: Foster professional, branded communication and provide educational resources regularly, establishing a consistent presence and brand for the revenue cycle.

· Regulatory Compliance and Risk Management: Ensure that all operations adhere to the latest regulatory frameworks. Partner with Chief Administrative Officer to address revenue cycle issues impacting compliance.

· Internal Standards and Benchmarking: Establish and maintain RCM KPIs, such as collection rates, AR days, and denial resolution times, comparing them against industry benchmarks to drive continuous improvement.

· Facilitation of Timely and Accurate Payer Enrollment: Ensure timely and accurate enrollment of all providers with payors, as well as ongoing maintenance of provider status.

· Leadership in Revenue Cycle Management: Represent Relias in national revenue cycle management forums, ensuring Relias is recognized for its RCM innovation and commitment to excellence.

Qualifications

• Bachelor’s degree in Finance, Business, Health Administration, or related field (Graduate Degree Preferred)
• Minimum of 10 years of healthcare RCM experience, particularly in emergency medicine and hospitalist services, with at least 5 years in a senior leadership role
• Certification as a Certified Revenue Cycle Representative (CRCR) from HFMA within 12 months of hire (if not already certified)
• Proven experience with physician (Pro Fee) revenue cycle management, preferably within emergency medicine and hospitalist physician environments is a requirement.
• Strong financial acumen, excellent interpersonal skills, and ability to present complex information to diverse audiences

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person