Associate Director, Revenue Cycle Management Optimization

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We’re changing lives every day.  For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts?  Do you inspire others with your kindness and joy?

We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Associate Director, Revenue Cycle Management (RCM) Optimization manages and organizes revenue strategy activities to maximize cash flow through the creation of effective, scalable business. The incumbent in this role assists with the strategic alignment and oversight of claims assembly and submission processes. In close collaboration with Billing, Coding, IT, and Business Intelligence departments, gains insight and understanding of the organization’s revenue streams to introduce, facilitate, and execute process improvement initiatives that drive best practices, achieve favorable collection of revenue, and minimize deficiencies in the revenue cycle process. The incumbent also serves as a subject matter expert on risk-adjustment and medical economics to aid in the development of revenue related products and tools.ESSENTIAL JOB DUTIES/RESPONSIBILITIES:

• Manages the development and implementation of revenue strategies to maximize profitability and value-based care outcomes.
• Develops and maintains internal controls to target revenue recovery throughout the organization by identifying operational, coding, billing, and reimbursement problems then recommending solutions.
• Evaluates and implements new technologies and systems to enhance revenue cycle processes.
• Facilitates and communicates optimization initiatives for improvements to the revenue management cycle.
• Works closely with RCM Operations leader to provide insights into areas of strategic focus.
• Collaborates with Product Management team to identify gaps in revenue management and subsequently designs products and tools to address these gaps.
• Partners with senior business stakeholders to identify, analyze, and prioritize RCM activities based on business value and urgency.
• Facilitates cross-functional collaboration and strategic alignment among RCM stakeholders, ABS Resources, and teams.
• Monitors and analyzes key performance indicators (KPIs) for assigned RCM functions, preparing regular reports for senior leadership.
• Leads change management efforts for new processes, technologies, and regulatory requirements within assigned areas.
• Supports the integration and alignment of revenue cycle management operational activities to drive standardization and streamline and increase operational efficiency.
• Ensures all critical business needs and requirements are identified and met with automated/manual processes.
• Stays informed of industry trends, regulatory changes, and emerging technologies in healthcare revenue cycle management, recommending best practices for implementation. Ensures compliance with all relevant healthcare regulations and standards.
• Manages payer data to determine denial and underpayment trends to accomplish business objectives. Manages internal data to determine leakage and gaps in the different business units.
• Monitors payer trends and identifies negative trends and then interfaces with payer representatives to resolve these issues.
• Conducts data processes and in-depth high-risk revenue analysis.
• Performs other duties as assigned and modified at manager’s discretion.

KNOWLEDGE, SKILLS AND ABILITIES:

• Strong business acumen and acuity
• In depth knowledge of Medicare, Medicaid, and commercial billing rules and regulations, coding, and reimbursement processes
• Comprehensive knowledge of Medicare program including but not limited to Risk Adjustment processes and Fee For Service.
• Knowledge of applicable federal, state, and local laws as they pertain to Billing & Collections
• Extensive understanding of all revenue cycle functions and dependencies
• Knowledge in data automation, data extraction, data visualization a plus
• Knowledge in quantitative and qualitative data analysis and statistical modeling
• Excellent leadership, written and verbal communication, interpersonal, time management, and organizational skills
• Strong analytical skills and proficiency in financial analysis
• Ability to work on various assignments simultaneously
• Ability to engage and build relationships with internal and external partners effectively and consistently
• Ability to lead a staff of professionals in a positive and productive manner through motivation, development, and mentorship
• Proficient in Microsoft Office Suite products including Word, Excel, PowerPoint, and Outlook; SSRS; Qlik Sense and MySQL plus a variety of other word-processing, spreadsheet, database, e-mail, and presentation software
• Ability and willingness to travel locally, regionally, and nationwide up to 10% of the time
• Spoken and written fluency in English
• This job requires use and exercise of independent judgment

EDUCATION AND EXPERIENCE CRITERIA:

• Bachelor’s Degree in healthcare administration, business administration, finance or related field OR additional experience above the minimum will be considered in lieu of the required education on a year-for-year basis; Master’s Degree preferred
• A minimum of five (5) years of direct hands-on process analyst experience in a relevant technical process role; including three (3) years of process/project management experience in a relevant technical role with documented cost-saving methods and techniques demonstrating strategic impact
• Expertise in Medical Economics and clinical informatics
• Expertise with risk-adjustment models and government business operations
• Leadership and management skills in a healthcare setting desirable

PAY RANGE:

$124,938 - $178,483 Salary

EMPLOYEE BENEFITS

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