VP Revenue Cycle

POSITION SUMMARY:

The Vice President Revenue Cycle (VP) position will provide centralized management for all revenue cycle functions within the BMC Health System. This position directs, manages and implements programs to insure efficient operations of the BMC and BUMG revenue cycle programs in order to generate sufficient cash flow to support operations and strategic initiatives. VP responsibilities include identifying, analyzing, reducing and resolving all revenue cycle issues associated with: hospital and professional billing and insurance collections, A/R resolution, guarantor collections, patient access/scheduling, charge description master, charge capture, revenue enhancement, cash applications, financial reporting, revenue cycle audits, training and development, information technology performance improvement, patient service center, clinical documentation improvement, utilization review oversight, and medical records (including coding). This position is responsible ensuring annual cash collection targets are achieved on a base of approximately $1.4 billion of hospital and professional fee net revenue.

The VP will be responsible for the overall outcomes of the Revenue Cycle including service level agreements (SLAs) which may involve of patient satisfaction, staff satisfaction, standardized processes, days revenue outstanding, and other revenue and expense targets. The VP will be responsible for developing and maintaining effective relationships with administrative, physician leadership across the multiple sites and WellSense senior leaders (BMCHS Health Plan). In addition, the VP will also promote working relationships with key external organizations; this would include other providers, payers, government entities and applicable professional associations.

Position: VP, Revenue Cycle

Department: Administration

Schedule: Full Time

ESSENTIAL DUTIES/RESPONSIBILITIES:

The objective of the Vice President Revenue Cycle is to manage all functions (hospital and professional) within the revenue cycle to include, but not limited to:

• Patient Access/Admitting, pre-registration
• Charge Description Master and revenue integrity functions
• Inpatient, outpatient and professional fee coding
• Clinical documentation improvement program
• Pre-financial clearance programs
• Utilization review oversight
• Hospital and professional fee billing
• Hospital and professional fee third party insurance collections
• Reimbursement related issues, including contract/underpayment and denial management
• Health information management, including documentation and coding
• Accounts receivable resolution and reconciliation
• Hospital and professional fee self-pay collections
• Management of all bad debt and related collection functions
• Revenue enhancement programs
• Cash application
• Revenue cycle quality improvement and auditing
• Training and development
• Information technology performance improvement
• Patient call center
• Patient and internal customer service
• Corporate imaging
• Credentialing
• Billing compliance
• Management of credit balance accounts receivable
• All revenue cycle related activities related to any entity or physician practice acquisitions
• The VP will manage the above-mentioned activities of the Revenue Cycle to insure cost effectiveness and organizational efficiency. Furthermore, this position provides strategic direction to these functions and how the functions inter-relate to the other functions within BMCHS and the clinical enterprise including Senior Management and PO leadership.
• The VP communicates the departmental activities to BMCHS senior management and to PO leadership as it relates to cash collections, customer service, accounts receivable results and revenue enhancement activities.
• Develops implements and direct various quality initiatives to ensure continuous monitoring and improvements within the revenue cycle processes of BMC and BUMG. This includes managing an overall departmental operating/capital budget(s) within pre-determined limits to insure operational efficiencies and obtaining pre-determined performance targets.
• Negotiates and establishes SLAs and associated frameworks in support of the organization's goals. Manages, communicates and aggressively pursues enterprise accounts receivable targets. Develops key performance metrics and reports results to senior leadership.
• Works with business partners to interpret trends in key performance metrics which will guide management decisions for achieving the periodic goals of the revenue cycle and the overall financial performance of the enterprise.
• Ensures that appropriate controls exist throughout the enterprise to create accountability and effective management of the enterprise revenue cycle.
• Stays current with regulatory, third party payor and contractual changes affecting the revenue cycle to ensure compliance.
• Participates and/or chairs various committees to provide leadership and revenue cycle expertise.
• Manages and develops a results oriented team, including director, manager and supervisor levels. Continuously assesses and develops an organizational structure that ensures high performance and achievement of goals.
• Facilitates the communication, coordination, and implementation of any enterprise business process or information system that has been impacted by regulatory, industry, third party payers, federal, or state requirement.

OTHER DUTIES:

• Ensures the delivery of high quality service to our patients in a cost effective manner, managing the revenue cycle in alignment with service s and associated scorecard metrics.
• Creates a customer service driven department adept at working collaboratively with physician and administrative colleagues throughout the Enterprise
• Holds ultimate accountability for revenue cycle strategic planning in support of the BMC and BUMG strategic direction and execution of the revenue cycle operating plan in support of the strategic plan.
• Demonstrates comprehensive understanding of inter-relationships of functional areas and how to enhance employee, financial and overall performance
• Supports and fosters opportunities to improve processes and acts as a catalyst for realizing these improvements
• Acts as a facilitator and generator of new ideas and a mediator on difficult issues
• Brings awareness of current external environment issues to the enterprise revenue cycle and the institution
• Leads the enterprise revenue cycle by chairing and serving on enterprise-wide projects/groups, task forces, councils and committees both internally and with key external organizations (providers, payers, associations, government, etc.)
• Creates and fosters a team oriented work environment
• Develops, coaches, and mentors staff for future leadership roles. Overall responsibility for succession planning and retention initiatives
• Ensures the planning, coordination, and preparation for year-end audits with public accounting firms and third-party auditors as they relate to enterprise revenue operations.
• Fiduciary responsibility for ensuring that compliance standards for providing accurate information on all patient billings are followed for the enterprise. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.
• Carries out other assignments or special projects as assigned.

JOB REQUIREMENTS

EDUCATION:

• Bachelor's degree required, preferably in business, management or a related field.
• Master's degree in business administration, accounting, finance or related field is preferred.

EXPERIENCE:

• Minimum of 10 years management experience required in the healthcare receivables field demonstrating ever increasing and progressive responsibilities, particularly in an academic teaching facility and/or large system CBO environment.
• Candidate must possess extensive knowledge of hospital and professional fee revenue cycle and regulatory requirements as they relate to the revenue cycle.
• The individual must have significant experience with payers, providers, hospitals and physicians and understand the commensurate requirements for facilitating accounts receivable resolution, cash collections, billing, revenue enhancement and patient service issues.
• Incumbent must possess strong presentation skills with the ability to effectively communicate to many different audience levels. Familiarity with computerized applications is essential. Also, experience within a centralized business office processing hospital and professional fee claims is preferred.

KNOWLEDGE AND SKILLS:

The expertise of the Vice President should include:

• Success in leading an organization(s) through complex change initiatives, ability to effectively influence change.
• Demonstrated competency and senior operational leadership experience in a large, complex organization with multiple locations and matrix accountabilities
• Experience in an integrated health system that includes large scale clinic(s) or group practice would be beneficial
• Ability to translate vision and strategy into clear actionable goals and be politically astute in achieving results
• Excellent and thorough understanding of funds flow between hospitals, school and clinical departments.
• Excellent, current and thorough understanding of all aspects of physician billing, accounts receivable and collections, RVU, site of service complexities, allied health professionals, provider enrollment, business office operations, etc.
• Financial management skills, including the ability to financially analyze data for operations, budgeting, auditing, forecasting; basic accounting knowledge; AR and reserve analysis, market analysis; staffing and financial reporting skills.
• Strong quantitative, analytic, and problem solving skills to evaluate all aspects of a problem or opportunity and draw valid conclusions to make or facilitate appropriate and timely decisions.
• Working knowledge of financial statements and the impact of the revenue cycle on them, including aging reports, bad-debt analysis, and calculation of bad-debt allowance.
• Cash-flow management skills, including forecasting and managing A/R.
• Working knowledge of patient registration, billing, health information management, A/R, cash-management requirements, managed care contractual terms and requirements, health insurance practices, industry regulatory requirements (compliance and HIPAA), business office operations, A/R and financial reporting technology, wage and hour regulations, basic accounting and industry standard for healthcare revenue resolution management practices.
• Demonstrated experience in diagnosing, evaluating, and developing corrective actions for problems in revenue-cycle operations, customer services, and payment.
• Broad knowledge of the healthcare industry, including insurance, managed care, and integrated delivery systems.
• Ability to forge effective working relationships with key executives to support an understanding of the financial implications of their operations.
• Ability to forge effective working relationships with key external government and non-government stakeholders, payers, and representatives to support and understand how their operations impact and affect BMC's financial performance
• Strong information-systems knowledge; system savvy with experience in successful conversions and upgrades.
• Ability to anticipate healthcare trends and alter the financial direction of the organization as necessary.
• Ability to analyze and resolve problems that affect the claim submission or resolution process, regardless of whether the problem originates in an area under direct or indirect control.
• Ability to recognize and analyze the impact of regulatory changes on the financial performance of professional revenue.
• Leadership skills to motivate cross-departmental teams' performance towards excellence and develop team concepts and consensus-building management styles. The ability to make a significant contribution to the organization's overall effectiveness.
• Strong organizational skills to manage multiple diverse priorities with high visibility and extremely detailed information.
• Communication and listening skills that reflect self confidence and diplomacy. The ability to communicate with varying levels in the organization and create an environment where resolution/solutions are created that reflect benefits to all parties impacted.
• Ability to present and communicate complex information effectively in both written and oral forms to a variety of audiences, including the Board, hospital and physician leadership.
• A proven mentor and coach, who knows how to develop talented staff.
• Commitment to life-long learning and improvement.

Req id: 27419