Job Details

Job Title

This position provides leadership and guidance for Steward Health Care Systems Centralized and Virtual Business Operations (CVBO). The position has direct responsibility for ensuring standardization, efficiency and effectiveness of operations for the following departments within Revenue Operations: Revenue Integrity, CDM, Statistical and Reporting Analytics, Reimbursement and Financial Analysts, Managed Care Contracting (performance, payor report cards/escalations), Cash Collection/projections, Vendor Management (early out, bad debt, auditing), Revenue Systems Analysts.

The AVP will serve as a change agent for those under their preview and will ensure that change is managed efficiently and effectively. The AVP of RCO will report to the National VP CVBO Revenue Operations and serves all facilities located in states.

Key Responsibilities

• Establish, oversee and improve the Revenue Integrity Team (structure, performance standards)
• Manage the CDM Team to include CDM Standardization/Streamline Project 2022-2023, Implementation of new CDM for Florida Market in 2022 (Aug-Oct)
• Manage Reimbursement Analysts Team responsible for Medicare Cost Reporting, State Medicaid Reporting, Charity Reporting, CMS Auditing
• Manage Financial Analysts Team responsible for market/region financial reporting and data analytics to regional Presidents and Revenue Officers
• Manage Statistical and Reporting Analytics team responsible for Revenue Cycle Data (SQL, DR, Tableau) distribution, reporting standardization across enterprise
• Member of Managed Care Contracting Executive Team Committee responsible for delivery and advisement of MCC Payor Performance, Report Cards, Escalations, Predictive analysis informing Steward MCC of opportunities for upcoming contract negotiations
• Management of RCO Vendor Services (early out, bad debt, auditing)
• Management of Cash Collection Team responsible for posting all insurance and self-pay reimbursement. AVP responsible for working closely with National VP to assemble and report Cash Collection Projections for each region weekly
• Management of Revenue Systems Analyst Team responsible for maintenance of all CVBO system dictionaries, users, updates, access for applications critical to Revenue Cycle Operations (Patient Access, HIM/Coding, Billing, Collections)
• Maintain a working knowledge of Medicare and Medicaid regulations and requirements relevant to role
• Support the billing and collection model for the CVBO.
• Identify and target opportunities for measuring and reporting company, hospital, and market billing and collection outcomes
• Strategically plan (change management) for regulatory and technological changes and improvements and the effect on workforce, processes, etc.
• Ensure a process is in place to develop and revise necessary operational tools, processes, and policies to ensure the success and continued operational improvement of departments and teams that support the RCM and CVBO operations.
• Develop and maintain organizational structures to meet operational support needs.
• Ensure Corporate management is briefed and knowledgeable on threats, challenges, and issues in and surrounding RCM and CVBO operations in areas of responsibility.
• Involvement in payer relations, JOC, escalations associated with denials/payment delays
• Maintain real-time understanding and outlier-management of RCM KPI's (ex. DNFB, clean claim, initial denials, AR >90, etc)
• Involved in Region/Facility Revenue Officer onboarding associated with RCM training
• Able to present overview of market RCM performance, trending and implement actions to achieve targets involving CVBO and associated RCM depts
• Foster and maintain a culture of accountability, improvement and recognition.
• Collaborate with hospital CROs, CNOs, HIM Directors, CDI Directors, Clinical Documentation Specialists (CDS), Case Management Directors, Patient Access, and other Revenue Cycle and Clinical Operations managers, and Group Leadership and Compliance departments.
• Monitor outsourced AR & BD Vendor Performance Metrics to meet expected SOW
• Administering tasks and responsibilities to Directors, Managers and other Leadership within CVBO and Revenue Cycle Operations.
• Applying problem-solving skills to address challenges.
• Interviewing and hiring directors and managers.
• Guiding directors and managers using leadership skills and providing necessary resources to departments.
• Overseeing the RCM & CVBO employee retention and recruitment efforts to end outcome of less turnover, higher satisfaction of employees thus increased retention.

Required Knowledge & Skills

• Corporate CVBO experience
• Corporate Revenue Integrity, CDM, Managed Care Contracting Performance, Reporting and Analytics experience
• Requires excellent verbal and written communication skills as position interacts with members of Executive Leadership Team at Corporate level (CRCO, CFO, COO), frequently interacts with Senior Leadership Teams at facilities, interacts daily with their direct reports who are VPs, Directors, Managers, and interacts at least monthly with staff within Revenue Cycle Management
• Strong leadership skills
• Decision-making, especially under pressure
• Adaptability to change and be a change agent for the organization

Education/Experience/Licensure/Technical/Other

• Education: Bachelor's Degree in Healthcare Administration/ Finance or related field required.
• Master's Degree in Healthcare Administration/Finance or related field, preferred
• Experience (Type & Length): 7-10+ Director or VP level management experience focus in CVBO or Revenue Cycle Management/Operations for multiple facilities located in multiple states
• Certification/Licensure: FHFMA or related certification is a plus.
• Software/Hardware: Proficient in Excel, Word, Outlook, PowerPoint, Teams, Visio. HCIS/Technical: Meditech Expanse Experience Preferred, EPIC or Cerner 5+ years