Vice President, EPIC Revenue Cycle Operations

Location: Burlington, MA
Job ID: 164259-1A
Date Posted: Oct 27, 2020
Category: Consultant

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Job Description

Welcome To

Welcome to Beth Israel Lahey Health. We are a new health care system that brings together academic medical centers and teaching hospitals, community and specialty hospitals, more than 4,000 physicians and 35,000 employees in a shared mission to expand access to great care and advance the science and practice of medicine through groundbreaking research and education.  

About the Job

This position will provide centralized management for all EPIC revenue cycle functions within the Beth Israel Lahey Health system. This currently includes the hospital and professional revenue cycle functions organized around Lahey Hospital and Medical Center, Northeast Health System (Beverly and Addison Gilbert, and Bayridge hospitals) and Winchester Hospital and associated employed physician organizations. It is anticipated that the job will expand to include two additional system hospitals and affiliated physicians within the next two years. This position directs, manages, and implements programs to insure efficient operations of the Lahey revenue cycle program in order to generate sufficient cash flow to support Lahey operations and strategic initiatives. Among the responsibilities of the Vice President, Revenue Cycle Operations are identifying, analyzing, reducing, and resolving all revenue cycle issues associated with: hospital and professional billing and insurance collections, A/R resolution, guarantor collections, charge description master, charge capture, revenue enhancement, cash applications, financial reporting, revenue cycle audits, training and development, information technology performance improvement, patient service center, clinical documentation improvement, and medical records (including coding).

He/she is responsible for ensuring annual cash collection targets are achieved on a base of approximately $2.2 billion of hospital and professional fee net revenue. The Vice President will be responsible for the overall outcomes of the revenue cycle and include service-level agreements (SLAs) which may involve patient satisfaction, staff satisfaction, standardized processes, days revenue outstanding, and other revenue and expense targets. The Vice President will develop and maintain effective relationships with administrative and physician leadership across the multiple sites. In addition, the Vice President will also promote working relationships with key external organizations; including other providers, payors, government entities, and applicable professional associations.

Reporting to the Vice President, EPIC Revenue Cycle Operations are the Director of Hospital Billing, Director of Professional Billing, Director of Professional Coding, Director of Customer Service, Director of Health Information Management and Directors of Patient Access and Registration.

Essential Duties & Responsibilities including but not limited to:

The objective of the Vice President, EPIC Revenue Cycle Operations is to manage all functions (hospital and professional) within the revenue cycle to include, but not limited to:

  • Inpatient, outpatient, and professional fee coding
  • Charge Description Master and revenue integrity (charge capture and coding) functions
  • Pre-financial clearance programs
  • Clinical documentation improvement program
  • Hospital and professional fee third party insurance collections
  • Hospital and professional fee billing
  • Health information management, including documentation and coding
  • Reimbursement related issues, including contract/underpayment and denial management
  • Hospital and professional fee self-pay collections
  • Accounts receivable resolution and reconciliation
  • Revenue enhancement programs
  • Management of all bad debt and related collection functions
  • Financial reporting Cash application
  • Training and development
  • Revenue cycle quality improvement and auditing
  • Patient call center Information technology performance improvement
  • Patient and internal customer service
  • Corporate imaging
  • Billing compliance
  • Credentialing
  • All revenue cycle related activities related to any entity or physician practice acquisitions
  • Management of credit balance accounts receivable
  • Manages the above-mentioned activities of the revenue cycle to ensure cost effectiveness and organizational efficiency. Furthermore, provides strategic direction to these functions and how the functions inter-relate to the other functions within the clinical enterprise, including senior management.
  • Oversees an operating budget of more than $70 million, including approximately 800 FTEs.
  • Communicates the departmental activities to senior management as it relates to cash flow, organizational profitability, customer service, accounts receivable results, and revenue enhancement activities.
  • 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 insure operational efficiencies and obtaining pre-determined performance targets.
  • Negotiates and establishes SLAs and associated frameworks in support of the organization’s goals. Manages, communicates, and aggressively pursues enterprise accounts receivable targets. Develops key performance metrics and reports results to senior leadership.
  • Works with business partners 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.
  • Ensures that appropriate controls exist throughout the enterprise to create accountability and effective management of the enterprise revenue cycle.
  • Stays current with regulatory, third party payor, and contractual changes affecting the revenue cycle to ensure compliance.
  • Participates and/or chairs various committees to provide leadership and lend revenue cycle expertise.
  • Manages and develops a results-oriented team, including director, manager and supervisor levels. Continuously assesses and develops an organizational structure that ensures high performance and achievement of goals.
  • Facilitates the communication, coordination, and implementation of any enterprise business process or information system that has been impacted by regulatory, industry, third-party payors, federal, or state requirement.

Other Duties:

  • Ensures the delivery of high-quality service to patients in a cost effective manner, managing the revenue cycle in alignment with SLAs and associated scorecard metrics.
  • Creates a customer service-driven department adept at working collaboratively with physician and administrative colleagues throughout the Enterprise.
  • Holds ultimate accountability for revenue cycle strategic planning in support of the system’s strategic direction and execution of the revenue cycle operating plan in support of the strategic plan.
  • Demonstrates comprehensive understanding of inter-relationships of functional areas and enhancing employee, financial, and overall performance.
  • Supports and fosters opportunities to improve processes and acts as a catalyst for realizing these improvements.
  • Acts as a facilitator and generator of new ideas and a mediator on difficult issues.
  • Brings awareness of current external environment issues to the enterprise revenue cycle and the institution.
  • Leads the enterprise revenue cycle by chairing and serving on enterprise-wide projects/groups, task forces, councils and committees both internally and with key external organizations (providers, payors, associations, government, etc.).
  • Creates and fosters a team-oriented work environment.
  • Develops, coaches, and mentors staff for future leadership roles. Responsible for succession planning and retention initiatives.
  • Ensures the planning, coordination, and preparation for year-end audits with public accounting firms and third-party auditors as they relate to enterprise revenue operations.
  • Fiduciary responsibility for ensuring that compliance standards for providing accurate information on all patient billings are followed for the enterprise. Ensures compliance with relevant regulations, standards, and directives from regulatory agencies and third-party payors.
  • Carries out other assignments or special projects as assigned.

Short-Term and Long-Term Expectations: The Vice President, Revenue Cycle Operations will be expected to:

Short Term:

  • Quickly gain credibility and the trust of subordinates, managers, and physicians.
  • Ensure the maintenance of a high standard of performance with all aspects of the EPIC revenue cycle environment
  • Develop metrics and reports to monitor performance against industry standards (UHC) and organizational goals.
  • Foster the development of teamwork and integration with the department

Longer Term:

  • Plan for the addition of two more hospital/physician organizations to the central services model within the next two years.
  • Anticipate how payment mechanisms will work in the future and prepare the revenue cycle department to make needed reforms. Work towards a global and capitated payment system.
  • Assess the current staff and develop plans for their professional growth and success.
  • Design and implement “patient friendly” bills.

Education:

  • Bachelor’s degree required, preferably in business, finance, health or public administration, management or a related field.
  • Master’s degree in hospital or business administration, accounting, finance, or related field is preferred.

Experience:

  • Minimum of 10 years’ management experience required in the healthcare field demonstrating ever-increasing and progressive responsibilities, particularly in an academic teaching facility and/or large system.
  • Candidate must possess knowledge of hospital and professional fee billing and regulatory requirements as they relate to the revenue cycle.
  • The individual must have experience with payors, providers, hospitals, and physicians, and understand the commensurate requirements for facilitating accounts receivable resolution, cash flow, billing, revenue enhancement, and patient access service issues.
  • Incumbent must possess strong presentation skills with the ability to effectively communicate to many different audience levels.
  • Familiarity with computerized applications is essential, in particular experience in an EPIC environment.
  • Experience leading a centralized business office processing hospital and professional fee claims.

Skills, Knowledge & Abilities:

  • Outstanding management skills and experience; proven track record in developing staff.
  • A strong commitment to quality and service excellence.
  • A sense of accountability, with an ability to instill this in others.
  • A strong work ethic and commitment to meet and exceed expectations.
  • A transparent and participative management style.
  • Demonstrated resourcefulness in setting priorities and guiding investment in people and systems.
  • Effective and articulate communicator. Strong diplomatic/mediation/negotiation skills.
  • Politically savvy and organizationally astute.
  • The professional presence to win people over and provide a high level of customer service.
  • Exhibit a calm and confident demeanor while working in a dynamic work environment.
  • Ability to thrive in an open, non-hierarchical, and informal culture.
  • Willingness to be hands-on when necessary.
  • An active and engaging listener.
  • Able to handle ambiguity and complexity.
  • Strong belief in the mission and determination to ensure the revenue cycle department remains best in class.

About Us

Beth Israel Lahey Health is an integrated system providing patients with better care wherever they are. Care informed by world-class research and education. We are doctors and nurses, technicians and social workers, innovators and educators, and so many others. All with a shared vision for what healthcare can and should be. We are committed to attracting, developing and retaining top talent. We strive to create a diverse and inclusive workplace that reflects the communities in which we work and serve. With a team approach to care, we encourage learning and growth at all levels and offer competitive salaries and benefits.

Equal Opportunity Employer/Minorities/Females/Disabled/Veterans.