VP of Revenue Cycle

JOB OVERVIEW

All potential employee candidates must be entrepreneurial, enthusiastic, and committed to performing their job in an ethical and proper manner at the highest level. The VP of Revenue Cycle is responsible for overseeing and coordinating all revenue cycle activities.  The goal of maximizing reimbursement in a cost-effective manner that also complies with federal, state and payer-specific billing requirements. The VP oversees the overall policies, objectives, and initiatives of the facilities’ revenue cycle activities to optimize the patient financial interaction along the care continuum. 

ESSENTIAL JOB FUNCTIONS/ RESPONSIBILITIES

• Manages the billing process to patients and third-party reimbursement claims; maintain supporting documentation files and current resident addresses. 
• Ensures due diligence in the research, analysis, and interpretation of patient medical records to identify and determine amount and nature of billable services, assignment, and sequencing of appropriate diagnostic/procedure billing codes for the purpose of reimbursement, in compliance with requirements of third-party insurance payers and accreditation standards. 
• Follow up on submitted claims; monitor unpaid claims, initiate tracers and resubmit claims as necessary. 
• Monitor billing to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices. 
• Monitor daily releases and correct errors. 
• Review and research inquiries regarding coding, charges, and denials on individual accounts.
• Process bad debts 
• Monitor medical records to identify lost revenue through inadequate documentation.
• Prepare periodic reports and trend analysis.
• Prepare special reports and research related projects as designated by management.
• Credential providers and ensures consistent compliance with all payer contracts. 
• Download electronic payments made to us from carriers 
• Assist Demographic personnel as needed to determine patient eligibility 
• Process End of Day and assist to Process End of Month 

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.  

EDUCATION/EXPERIENCE

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. 

• 7 plus years (Dir) / 10 plus years (VP) Revenue Cycle Management (RCM) required  
• Medicaid and Commercial experience required  
• SPOT industry experience required  
• ABA industry experience preferred  
• Multi-state & multi-site experience required  
• Build, document, and maintain RCM/Billing workflows  
• Must partner with clinical team on coding & documentation requirements  
• Keeping up with and implementing CMS and payer coding and process updates  
• Track record of successful cash collections  
• Benchmark and minimize DSO, denials, rejections, and Billing team’s productivity  
• Manage Charge Master, Gross to Net, Write-offs and refund policies, as well as other department policies and procedures  
• Self-starter, able to work with minimal to no supervision  
• Strong in SQL, Excel, and other MS Office programs such as VBA and/or other programming knowledge and experience  
• Excellent planning and organizational skills to balance and prioritize work. 
• Adhere to all Company policies 

LANGUAGE SKILLS 

Ability to read, analyze, and interpret common information, reports, and other documents. Ability to respond to common inquires or complaints from customers, regulatory agencies, or company representatives. Ability to effectively present information to management.  

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.  

While performing the responsibilities of the job, the employee is required to talk and hear. The employee is often required to sit and use their hands and fingers, to handle or feel. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and to stoop, kneel, crouch or crawl. Additionally, the employee must be able to lift about 20 pounds. 

WORK ENVIRONMENT 

While performing the responsibilities of the job, these work environment characteristics are representative of the environment the job holder will encounter. Reasonable accommodations may be made to enable people with disabilities to perform the essential functions of the job. 

This job operates primarily in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.   

ESSENTIAL COMPETENCIES 

• Functional/ Technical Skills 
• Attention to Detail 
• Problem Solving Skills 
• Time Management Skills