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Vice President, Revenue Cycle

1 week ago

Gisborne, Gisborne, New Zealand Tbwa ChiatDay Inc Full time

Vice President, Revenue Cycle & ContractingEast Coast, USA.About Forge Health:We are a mission-driven outpatient mental health and substance use provider dedicated to providing the highest quality, affordable, and effective care to individuals, families, and communities in need.
We are leading the charge in driving innovation, improving care delivery, and shaping the future of behavioral healthcare.The Role:You will lead and oversee all aspects of Forge Health's revenue cycle management (RCM) and payer contracting functions and initiatives.
This role will be responsible for driving achievement of RCM performance through continuous optimization of all revenue cycle operations and improvement of key processes.Key Responsibilities:Oversee all aspects of revenue cycle functions and initiatives, including strategic thought leadership on mental health and substance use disorder services with commercial health plans, state Medicaid, and managed-care organizations, and Medicare.Directly manage the Revenue Cycle operations team, ensuring operational execution on timely, high-quality billing submissions.Drive continuous optimization of all revenue cycle operations by measuring, analyzing, and interpreting revenue cycle and reimbursement data to uncover trends and insights in revenue processes, payer-specific reimbursement, and other critical aspects of reimbursement.Establish measures of performance metrics and create dashboards that incorporate both internal and external payment data to identify key improvement areas to drive efficiencies and to ensure strong alignment and accountability on the team.Extract and compile data from various system sources to develop analyses leading to potential revenue cycle opportunities, conducting analyses related to billing system setup, charge capture, billing, and/or patient financial services.Develop, implement – and revise as necessary – revenue cycle management policies and procedures, process improvements, tools, and other resources (e.g.
standardized playbooks, communication templates, training materials, resource guides, automation features, advanced tooling, etc.)
that will maximize efficiency and optimize performance.Provide senior leadership oversight of the revenue cycle operation, driving performance/operational planning, developing and monitoring performance objectives for the director and their direct reports.Oversee all aspects of existing and new payer contracts, including developing and managing an internal payer checklist to track, monitor, and proactively address credentialing, billing, and information integrity matters.Serve as subject matter expert and go-to person for all revenue, payer contracting, and reimbursement-related matters – including payer-specific requirements, reimbursement logic, accreditation requirements, and emerging trends and methodologies in managed care contracting – both internally and externally.Apply current knowledge and understanding of regulations, industry trends, current best practices, new developments, and applicable laws to ensure operational and financial effectiveness for revenue cycle functions.
Partner to ensure regulatory compliance for all areas of responsibility.Proactively identify situations which require intervention (i.e.
denials, underpayments, and other issues).
Plan, prepare, and conduct corrective course of action(s) in partnership with key stakeholders.Identify and ensure revenue cycle management training needs at all levels of the organization, and foster change to achieve performance improvement initiatives.Monitor relevant policy at payers, states, and at the national level, and assess opportunities and threats related to emerging and evolving issues.Prepare impactful reports, analytics, summaries, and visualizations to communicate findings.Payer Contracting:Develop, recommend, and implement payer contracting strategy for fee-for-service and value-based initiatives with commercial health plans, Medicaid, and Medicare partners – assist in leading and driving negotiations with existing and new payer partners.Create, develop, and maintain contacts with existing and potential contracting partners of new and existing payers.Rapidly approach payers to obtain new or improved contracts, quickly submitting new applications, following up on status, and escalating as needed to overcome barriers.Execute administrative duties as required, including maintaining lists of provider relations contacts, preparing reports on in-network payer status, and organizing contracted fee schedules, plans/products/networks, and contract agreements.Serve as the subject matter expert related to payer-specific requirements, reimbursement logic, accreditation requirements and other critical aspects of payer contracts.
Ensures contracting efforts remain aligned with Forge Health strategic plan/goals.Provide input to senior management and key stakeholders relative to business development and strategic positioning as it relates to payer strategy including emerging trends and methodologies in managed care contracting, payer relations and new payment models that support the strategic goals of Forge Health.Assess performance to identify need for amendments of existing contracts.For new relationships or service lines, perform business and market analysis to determine viability of right type of contracting.Requirements:At least ten (10) years of experience in revenue cycle management in healthcare in positions of increasing responsibility – working with commercial health insurance companies, Medicaid programs, and Medicare programs – required.Experience in revenue cycle management in behavioral health preferred.Experience with value-based care payment arrangements preferred.Demonstrate comprehension of payer contracts, with special attention to complexities and details.Problem-solving skills in order to identify problems, evaluate options and execute solutions.Must have relevant healthcare industry knowledge and market awareness.
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