VP, Revenue Cycle Management

Key Responsibilities:

Revenue Cycle Oversight:

• Manage end-to-end revenue cycle processes, specifically Medicare and Medicare Advantage billing for RPM, RTM, CCM, and Establishing Physician-Patient Relationship.
• Ensure compliance with federal and state regulations, particularly related to Medicare billing.
• Lead the development and implementation of standardized billing, coding, and reimbursement practices across the company.
   

Billing & Contracting Expertise:

• Lead the setup of contracting with payers, ensuring optimal terms for the organization.
• Oversee the negotiation and relationships with Medicare Administrative Contractors (MACs) to ensure seamless claims processing and payment.
   

Denials Management:

• Develop strategies to reduce denials, improve collections, and manage accounts receivable.
• Oversee denials management teams to maximize revenue recovery and minimize losses.

Team Leadership & Development:

• Build, scale, and manage onshore and offshore teams that handle revenue cycle operations, billing, and claims management.
• Foster a high-performing, collaborative culture within the revenue cycle teams, ensuring that all members are aligned with company objectives.

Off-shoring Strategy & Execution:

• Lead the design and execution of off-shoring strategies to increase efficiency and reduce operational costs.
• Set up offshore teams with proper training and performance monitoring to maintain high-quality standards.

Payer Relations & Contracting:

• Establish and maintain payer contracts to ensure the organization is well-positioned for revenue maximization.
• Lead efforts in payer contracting and compliance, ensuring all agreements align with company growth and regulatory requirements.

Metrics & Reporting:
 

• Utilize KPIs and performance metrics to track revenue cycle efficiency, identifying areas for improvement.
• Ensure timely and accurate reporting to executive leadership on all key revenue cycle indicators.
• Provide the monthly Management Operating Review (MOR) report for Revenue Cycle and presents to key corporate stakeholders

Requirements:

• Must have 10+ years of experience dealing with physician group billing – CMS FFS billing (Part B).  
• Must have a proven track record of payer contracting and demonstrating a high collection rate. 
• Willing to get hands-on. 
• Bachelor’s degree in Health Administration, Business, or a related field; advanced degree preferred. 
• Strong knowledge of medical billing regulations and compliance requirements.
• Post-acute care experience is preferred.