Vice President, Revenue Cycle and Payor Relations chez Valleyhealthlink

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Job Description

The Vice President of Revenue Cycle and Payor Relations is responsible for maintaining the relationship with our outsourced revenue cycle management (RCM) partner that provided end-to-end RCM services, in house payor contracting functions, and in house payor credentialing. This role involves driving the achievement of RCM performance through continuous optimization of revenue cycle operations, advancing strategies with RCM partner and operational leaders, and improvement of key processes and IT capabilities. The VP will also lead strategic development and oversight of payor contracting, including governmental and non-governmental, fee-for-service and value-based care arrangements, while fostering key relationships with payor partners.

Key Responsibilities

Revenue Cycle Management: Oversee the entire outsourced RCM process, including patient access, scheduling, billing, charge reconciliation, payor compliance, collections, health information management, and revenue cycle integrity. Ensure proper operational systems and controls are in place to drive revenue optimization and scalability.  Develops/maintains RCM policies and procedures, ensuring that all processes are appropriate to meet regulatory and payor requirements.  This includes, but is not limited to, Medicare and Medicaid regulations, federal and state laws, Det Norske Veritas (DNV), and relevant managed care language.

Payor Relations: Develop and execute strategies for payor engagement, negotiate contractual and reimbursement terms, and manage relationships with commercial and government payors.

Contracting: Lead negotiations and manage contracts with third-party payors, ensuring favorable contract terms, competitive rates, and assessing innovative strategies.

Credentialing: Oversee credentialing operations to ensure timely and accurate provider enrollment with payors.

Leadership: Directly manage the outsourced RCM relationship, the payor relations team, and the credentialing team.  This person will need to interact with operators, internal audit, legal, and all levels of the organization.  Chair the Managed Care Committee.  In conjunction with CFO, develop VHS revenue goals and objectives.

Strategic Planning: Collaborate with the executive team to develop and implement strategic initiatives that align with the company's financial and operational goals.  Work with various external organizations, such as Virginia Hospital & Healthcare Association, RCM Vendor Committees, and other associations that could provide strategic insight.

Performance Monitoring: Continuously monitor and analyze revenue cycle performance metrics, identifying areas for improvement and implementing corrective actions.  Act as a catalyst to timely implementation with information technology and operational partners.

Education

Bachelor's degree in healthcare administration, business, finance, or a related field is required.

Master's degree in healthcare administration, business, finance, or a related field is required.

Experience

Minimum of 10 years of experience in revenue cycle management, payor relations, or healthcare administration, with at least 5 years in a leadership role, is required.

Qualifications

Strong negotiation, analytical, and problem-solving skills.

Excellent communication and interpersonal abilities.

Proficiency in revenue cycle management software and tools.

In-depth understanding of healthcare reimbursement, payor contracting, and credentialing processes.

Familiarity with CMS guidelines and industry best practices.

Benefits

At Valley Health, we believe everyone is a caregiver, and our goal is to create an environment where our caregivers thrive physically, financially, and emotionally. In addition to a competitive salary, our most popular benefits for full-time employees include:

• A Zero-Deductible Health Plan
• Dental and vision insurance
• Generous Paid Time Off
• Tuition Assistance
• Retirement Savings Match
• A Robust Employee Assistance Program to help with many aspects of emotional wellbeing
• Membership to Healthy U: An Incentive-Based Wellness Program

Valley Health also offers a health savings account & flexible spending account for childcare, life insurance, short-term and long-term disability, and professional development. In addition, several perks come with working for the largest employer in the region, such as discounts to on-campus dining, and more.

To see the full scale of what we offer, visit valleyhealthbenefits.com.