VP Revenue Cycle & Care Management

The VP Revenue Cycle & Care Management will lead the integrated clinical and financial functions to contribute to optimal reimbursement for efficient clinical services. Oversee all administrative functions to contribute to the authorization, capture, management, and collection of patient service revenue. Will be responsible to enhance and maintain a properly functioning care management and revenue cycle process through a cross department
organizational structure and dual reporting relationship to the CFO and COO. Will align clinical services and programs with revenue capture to achieve the highest level of clinical and financial outcomes. The VP will concentrate on financial and clinical resources to assist the management team and applicable department heads to improve the overall effectiveness and efficiencies of care management to support timely billing and contract compliance. Critical responsibilities include achievement of annual and periodic goals for significant statistical indicators of utilization and revenue cycle performance and for the organization's overall financial performance. Will serve as the functional representative in leadership meetings regarding care management and revenue cycle improvements and initiatives. Will maintain a focus on continuous improvement within the area of influence and deliver the highest degree of quality service possible. The VP will work on special projects as directed by the CFO and COO.

• Lead the strategic planning of care management and revenue cycle functions, including establishing the vision, mission, short-term and long-term goals.

• Plan, implement, direct, and evaluate care management and revenue cycle functions on a strategic and operational level to support the vision, mission and strategic plan for CNMC.

• Develop a communication strategy and tools to ensure the effective communication of all departmental programs to CNMC management and staff.

• Complete (or contribute to the completion of) various financial forecasts, including cost center salary and direct expenses, month-end financial reporting, receivables levels (days in AR and aging), cost center productivity, and any long-range strategic plans for the department.

• Direct the administration and measurement of care management activities across the enterprise to achieve the best possible outcome and financial return through innovative programs related to the strategic direction of the organization.

• Work to continually enhance, improve and assure optimal efficiency of these programs/ business units.

• Assess and monitor organizational staffing requirements and align managed functions to effectively and efficiently meet organizational needs.

• Define, set and utilize appropriate key performance indicators and quality measures for care management and revenue cycle functions.

• Build the breadth and depth of the organization's human capacity through competency assessment, succession planning and career development.

• Form a top team that possesses balanced capabilities to setting the mission, values and norms, as well as to hold the team members accountable individually and as a group for high quality results.

• Establish, build and sustain professional contacts with key stake holders internally and externally.

• Serve as a resource to leaders across the organization looking to enhance care management and revenue cycle processes and outcomes.

• Identify opportunities in the use of existing and new administrative and clinical information technology and decision-support tools to improve care management and revenue cycle performance efficiency and productivity.

• Leverage the use of administrative and clinical information technology and decision-support tools in process and performance improvement related to patient access, care management, patient financial services, health information management, and revenue integrity.

• Actively sponsor the utilization and continuous upgrade of information management capabilities to meet current and future organizational needs related to revenue cycle and care management.

• Lead the strategic planning and development of operating and capital budgets for the managed functions. Ensure compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payers.

• Monitor key performance indicator financial reports and evaluate variances; recommend interventions for variance corrections; oversee the financial interface between and performance analysis of the patient financial services functions and fiscal services functions to produce and report reliable metrics.

• Oversee the integrity of financial and clinical interfaces, while facilitating the development of strategic system planning to enhance care delivery which will result in optimal revenue capture.

• Oversee the maintenance of the Charge Description Master and Revenue Integrity from a regulatory and strategic perspective.

• Evaluate and monitor performance of Managed Care contracts for problematic terms, language, administrative/clinical red-tape and loopholes with financial implications.

• Supervise internal and external audits related to individual accounts and revenue cycle processes.

• Lead care management programs to ensure efficient and effective care management throughout the enterprise. Oversee the clinical financial interface with care delivery teams, post-acute providers, community resources, state programs and payers for services to achieve highest level clinical, financial, quality and satisfaction outcomes.

• Monitor key performance indicator utilization reports and evaluate variances; recommend interventions for variance corrections.

• Develop and support structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in interdisciplinary care coordination for optimal care delivery across the enterprise.

• Integrate departments and teams to form collaborative partnerships to improve service delivery in a cost effective and satisfying manner.

• Identify the emerging care delivery models and innovations to be assimilated, integrated and introduced within the organization which will significantly impact the enterprise; create opportunities in the use of best practice clinical pathways to reduce costs and improve clinical effectiveness.

• Direct and evaluate the effectiveness of the utilization management activities and programs, then implement processes to continually improve performance, mitigate financial losses, and enhance reimbursement.