VP Revenue Cycle Optimization

Job Description

POSITION SUMMARY

Primary responsibility for leading and managing all aspects of revenue cycle for the organization, including negotiating with payers, maintaining relationship and monitoring of third-party billing organization and EPIC hosting organization, developing and implementing revenue optimization strategies, regulatory compliance with third-party insurers, and oversight of financial counselors and patient accounts.   Develops and maintains billing and reporting systems.  Hires, supervises, trains and evaluates staff on the Revenue Cycle, Revenue Optimization and Financial Counselor Teams.  Coordinates credentialing activities.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES

Management (20%)

·Hires and retains a diverse, highly qualified staff and provides ongoing performance feedback and maintains a safe and professional work environment.

·Trains or assists in training staff in other departments on revenue cycle related areas (both administrative and program) as needed.

·Evaluates staff in a timely manner in accordance with PPGNY’s policies.

·Performs other educational and experience related duties as required.

Revenue Cycle Optimization and Revenue Cycle Liaison (25%)

·Performs analysis of revenue cycle trends and identifies areas of focus to reduce denials and increase overall collections.

·Performs root cause analysis for areas identified and proposes solutions to achieve overall enhancement of revenue.

·Works closely with EPIC hosting organization to identify and implement automated solutions.

·Collaborates with third party RCM vendor and health center operations to implement process changes.

·Develop and roll out SOP’s to document process changes.

·Train impacted staff on changes.

·Resolves third-party billing difficulties that are beyond the experience of PPGNY or third-party vendor staff.

Revenue Cycle (25%)

·Serves as the organization’s main contact with outsourced RCM vendor to identify, resolve and prevent future issues.  This includes setting up metrics to evaluate the RCM vendor’s performance.

·Perform under and over payment audits

·Oversee the PPGNY WQ’s to ensure work is done timely and accurately

·Perform monthly monitoring of key metrics and identify issues driving underperformance

·Develops/maintains procedures for internal control.

·Works closely with other departments on internal and external reporting as it relates to clinical revenue.

RCM compliance (10%)

·Coordinates the coding audit on a periodic basis conducted by an outside agency, and partners with clinical services leadership to provide training and feedback to the clinical providers on their performance and areas for improvement.

·Acts as primary interface with Medicaid and other third-party billing authorities, working with them to resolve in appropriate denials.

·Actively maintains an up-to-date knowledge base of developments in third-party billing, such as changes in Medicaid reporting requirements.  Keeps the CFO, CEO and other appropriate staff informed of same.  Modifies department procedures to respond to such developments; and instructs and monitors staff with regard to procedure modifications.

Managed care contracting (10%)

·Works with external managed care consultant in negotiating periodic rate changes and contracting with third party payers.

·Works closely with managed care contracting consultant to maximize reimbursement, including escalating revenue cycle issues that are not consistent with payer contracts.

Monitoring reporting tools (10%)

·Creates and monitors proper reporting tools for analytical review of the performance of the revenue cycle, including accounts receivable, write offs, payment posting, and charge entry.

·Develops reporting tools to monitor productivity and quality of work performed by staff that impacts RCM results, including front desk, financial counselors, and third-party RCM vendor.

·Works closely with Data Analytics team to develop dashboards, scorecards and other tools to monitor performance.

CORE COMPETENCIES

·A demonstrated commitment to PPGNY’s mission related to bodily autonomy, health equity, gender and racial justice

·A demonstrated commitment to learning about and enhancing practices related to racial equity and its impact on healthcare systems.

·Strong relationship building and communication skills, including an ability to work and build trust across cultural differences related to related to race, class, age, gender, gender identity and expression, sexual orientation, religion, ethnicity, national origin or ability; and to reflect on one’s personal identity with humility.

·Ability to manage and mentor a culturally diverse team, including creating and sustaining an organizational culture that fosters inclusiveness and equity, and providing positive and developmental feedback and accountability related to practices including but not limited to equity.

·Strong knowledge of data and analytics to ensure good decision making, performance measurement and financial analysis.

·Ability to lead and advise cross-organization workgroups.

·Customer service and interpersonal skills and the ability to coordinate work with others, both internally and externally, to accomplish tasks.

·Strong leadership skills, including ability to identify talent, mentor existing staff, and delegate work as appropriate.

·Engages in mutual problem solving

·Facilitates continuous process improvements

·Strong time management skills, including ability to work in a high distraction environment and to juggle multiple deliverables at one time.

·Strong project management skills, identifying all steps required to meet a deliverable, key stakeholders, deliverables by other units in order to achieve goals, and barriers to success.

REQUIRED SKILLS/ABILITIES:

Interpersonal

·Excellent customer service and communication skills.

·Ability to remain focused and calm in stressful situations.

·Excellent interpersonal, written and verbal skills.

·Ability to develop and maintain effective, professional relationships with internal and external stakeholders.

·Ability to work effectively as part of team.

Technical

·Proficient in Microsoft Office Suite or similar software.

·Deep understanding of an EPIC EMR environment.

Superior data management and data analysis skills.

Subject Matter Knowledge

·Extensive experience in revenue cycle management and optimization.

·Proven track record in strategic planning and operational excellence.

·Proven track record of implementing process improvement strategies and strong change management skills.

·Strong experience in risk management and negotiation skills.

·Knowledge of regulatory requirements of health care providers.

Work Habits/Attributes

·Excellent organizational skills

·Excellent project management skills, including the ability to juggle multiple priorities at one time.

·Outstanding time management skills, including the ability to work under deadline.

·The ability to produce high quality work in a fast-paced environment with changing and/or competing priorities.

·Ability to exercise sound judgment and independent decision-making skills.

·Ability to produce reliable, high-quality work with minimal direct supervision.

·Ability to exercise discretion in the handling of confidential information

·Ability to build and lead high-performing teams

·Comfort making sound strategic decisions in the face of uncertain or incomplete information

·Possess strong work ethic

REQUIRED QUALIFICATIONS

• Bachelor’s degree
• 10+ years of specifically related experience including a minimum of three (3) years of supervisory experience.  Requires working understanding and facility with contemporary information systems applications and the ability to communicate clearly and effectively both verbally and in writing.
• Ability to work overtime

TYPICAL PHYSICAL DEMANDS

• Requires prolonged sitting and repetitive tasks including use of a computer. Periodic standing, walking, bending. Requires lifting or moving of up to 15 pounds. Visual acuity sufficient to perform frequent work on a computer screen and review printed reports and other materials. Requires the ability to hear and to communicate orally with others. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets, and will require reaching, grasping, pushing and pulling.

TYPICAL WORKING CONDITIONS

• This job operates in a professional office environment. Potential exposure to communicable diseases and other conditions in a health center environment. Requires flexible schedule and during peak activity periods work in excess of 7.5 hours per day and/or 37.5 hours per week.

Schedule and Location

• Monday-Friday, 37.5 hours/week
• This position supports the organization enterprise‑wide and may be based out of any of PPGNY New York State office locations, depending on the candidate’s proximity and business needs.
• The role follows a hybrid work schedule, with a combination of in‑office and remote work. The selected candidate will be expected to work onsite at the NY location closest to their residence as required (e.g., meetings, collaboration, or operational needs).
• Primary reporting location will be determined at the time of hire.
• Hybrid work arrangements are subject to change based on organizational needs and may vary by department.

$233,000 - $260,000 a year

PPGNY’s benefits package includes:

Generous PTO and holiday schedule

Medical, dental and vision coverage options for you and eligible dependents

FSA, HSA, Commuter pre-tax reimbursement funds

Short- and Long-Term Disability, Free Basic Life and AD&D

401(k) Retirement Plan with Safe Harbor contributions after 1 year of employment

All positions at PPGNY require:

Proof of immunization or immunity to certain communicable diseases (including influenza during the flu season and Covid-19) and testing for tuberculosis. These certifications are required by the NYC DOHMH Health Code, NYSDOH and OSHA.

Planned Parenthood of Greater New York (PPGNY) is a leading provider, educator, and advocate of sexual and reproductive health care in New York State. PPGNY is proud to provide a wide-range of family planning services at our brick-and-mortar health centers and mobile care units. We care for everyone regardless of their immigration status, zip code or ability to pay. PPGNY’s education and outreach programs are backed by medically accurate, evidence-based information that allows people to make informed decisions about their health and future. As a voice for reproductive freedom, PPGNY supports legislation and policies that ensure all New Yorkers have access to the full range of reproductive health care and education.

At PPGNY, we provide the absolute best care to our patients and our communities through innovative health care delivery and education programming. We care for everyone who walks through our doors regardless of insurance, ability to pay or immigration status. As a leading voice for reproductive freedom, PPGNY fiercely advocates for policies to ensure that all New Yorkers will have access to the full range of reproductive health care services and information.

PPGNY is committed to diversity, equity, and inclusion. We believe we are most impactful when people with a wide range of backgrounds, experiences, and identities come together with common purpose. We encourage candidates from all backgrounds to apply.