SVP Revenue Cycle

Job Profile Summary

​This role focuses on activities related to revenue cycle operations such as billing, collections, and payment processing. In addition, this role focuses on performing the following Revenue Cycle Leadership duties: Controls, directs, and participates in the activities of the organization through a hierarchy of managers and supervisors. Responsibilities also include long-term strategic planning, determining the policies of the organization, and allocating its resources and making decisions regarding organization growth and diversification to accomplish entity's vision. An executive role that provides strategic vision and/or tactical/strategic direction across multiple teams with the majority of time spent on overseeing area of responsibility and directing the responsibilities of employees. Goal achievement is typically accomplished through performance of direct and/or indirect reports. An entity function head or enterprise sub-function head role accountable to establish and implement strategies that have short to mid-term (1-3 years) impact on business results in alignment with organization or function objectives. Leads multiple teams of lower-level executives, directors/senior managers and managers and develops short to mid-term (1-3 years) plans for optimizing the organization, function or sub-function and the talent required to execute strategies in job area.

Job Overview

This position provides centralized management for all Revenue Cycle functions for Tufts Medicine and its affiliate members. The leader will direct, manage and implement programs to ensure efficient operations of the organization’s Revenue Cycle program in order to generate sufficient cash flow to support operations and strategic initiatives. Responsible for identifying, analyzing, reducing and resolving all Revenue Cycle issues. Responsible for developing and maintaining effective relationships with administrative, clinical department, and physician leadership across the organization. The leader will also promote working relationships with key external organizations; this would include other providers, payers, government entities and applicable professional associations. Accountable for the following functions: Patient Access Management, Pre-Services, Health Information Management, Clinical Documentation Integrity and Utilization Review, Revenue Integrity, Patient Financial Services, Home Care/ Post- Acute Revenue Systems, Physician Services and Operational Strategy and Optimization.

Job Description

Minimum Qualifications:

1. Bachelor’s degree in Business or Healthcare Management.

2. Ten (10) years of progressive leadership experience in healthcare Account Receivables.

3. Extensive knowledge of hospital and professional fee Revenue Cycle and regulatory requirements as they relate to the Revenue Cycle.

4. Significant experience with payers, providers, hospitals and physicians.

5. Extensive understanding of the requirements for facilitating accounts receivable resolution, cash flow, billing, revenue enhancement and patient service issues.

Preferred Qualifications:

1. Master’s degree in Business or Healthcare Management.

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

1. Manages revenue cycle activities to insure cost effectiveness, organizational efficiency, and optimal collection rates.

2. Provides strategic direction to these functions and how the functions in question inter-relate to the other functions within the organization.

3. Communicate the Revenue Cycle departmental activities to Senior Management as it relates to cash flow, organizational profitability, customer service, Accounts Receivable results and revenue enhancement activities.

4. Develops, implements and directs various quality initiatives to ensure continuous monitoring and improvements within the revenue cycle process. This includes managing an overall departmental operating/capital budget(s) within pre-determined limits to ensure operational efficiencies and obtaining pre-determined performance targets.

5. Negotiates and establishes SLAs and associated frameworks in support of the organization’s goals.

6. Implements and manages third-party vendor relationships as necessary.

7. Develops a structure for innovation and establish cross-departmental collaborations to transform care delivery and experience.

8. Models leadership behaviors and lead as a unified team to drive organizational alignment.

9. Directs the strategy, goals and objectives of the department to align with the organization’s business plan.

10. Manages, communicates and pursues enterprise Accounts Receivable targets.

11. Partners with key stakeholders to interpret trends in Key Performance Metrics which will guide management decisions for achieving the periodic goals of the revenue cycle and the overall financial performance of the enterprise.

12. Partners with Payer Relations/Contracting communicating Payer performance trends, providing JOC meeting support and alignment with the provider adjudication of contract terms for realization negotiated reimbursement rates.

13. Ensures that appropriate controls exist throughout the enterprise to create accountability and effective management of the enterprise Revenue Cycle.

14. Remains up to date with regulatory, third-party payer and contractual changes affecting the revenue cycle to ensure compliance.

15. Participates and/or chairs various committees to provide leadership and lend Revenue Cycle expertise.

16. Manages and develops a results-oriented team. Continuously assesses and develops an organizational structure that ensures high performance and achievement of goals.

17. Facilitates the communication, coordination, and implementation of any enterprise business process or information system that has been impacted by regulatory, industry, third party payers, federal, or state requirement.

18. Ensures that all departments meet service level agreements, quality standards, and performance goals based on the development and monitoring of cost and process metrics.

19. Advocates for the desired culture in high-level planning and decision making, with a focus on performance accountability and achieving greater operational efficiencies.

20. Develops, leads and manages a diverse team ensuring that succession and development plans are in place to achieve the company’s goals.

21. Acts as a key participant in the strategic and long-range planning of the organization. Integrate long range plans with operational plans and capital priorities.

22. Analyzes operations to evaluate performance of the team in meeting objectives or to determine areas of potential cost reduction, program improvement, or policy changes.

Physical Requirements:

1. Professional office environment with typical office requirements such as computers, phones, photocopiers, filing cabinets, etc.

2. This is largely a sedentary role, which involves sitting most of the time, but may involve movements such as walking, standing, reaching, ascending / descending stairs and operating office equipment.

3. Frequently required to speak, hear, communicate and exchange information.

4. Able to see and read computer displays, read fine print, and/or normal type size print and distinguish letters, numbers and symbols.

5. Occasionally lift and/or move up to 25 pounds.

Skills & Abilities:

1. Strong presentation skills with the ability to effectively communicate with many different audience levels.

2. Ability to successfully build relationships with key stakeholders; CFOs and Executive Leadership team and both clinical and financial leaders across the system

3. Ability to propose enhancements to operational processes to improve efficiency and/or effectiveness of all internal accounting and compliance controls

4. Current knowledge and understanding of regulations, industry trends, current best practices, new developments, and applicable laws to ensure operational and financial effectiveness.

5. Ability to partner to ensure regulatory compliance for all areas of responsibility.