Department Lead, Revenue Cycle Operations

Revenue Cycle Management: 

• Oversee functions of revenue cycle production, which could include eligibility, patient registration, appeals, denial management, claims management, patient billing, inbound/outbound calls, and/or payment posting. 
• Ensure turnaround time (TAT), quality, and productivity goals are met/exceeded. Point of contact between production and QA team.  Monitor KPI reporting to validate compliance with established goals.
• Develop and implement policies and procedures to optimize revenue capture and minimize denials and write-offs.
• Ensure accurate and timely processing of all billing and reimbursement activities. 
• Champion process improvements and productivity leaps – from manual workflow changes to system enhancements to leveraging RPA & AI.

Team Leadership and Development: 

• Lead, mentor, and develop high-performing BPO revenue cycle teams.
• Assists AVP/VP with department staffing plan including offshore resources and planned automations. Demonstrated expertise in resource efficiency and optimization.
• Foster a culture of continuous improvement, accountability, and excellence and ensure outcomes of process improvement initiatives are implemented and achieve expected results.
• Own production training plan relative to succession plan. Provide ongoing training and development opportunities to staff to enhance their skills and knowledge. 
• Integrate offshore and onshore teams – the outcome being a collaborative team working on Quadax’s goals together. Occasional travel to India and/or the Philippines may be requested (not more than 1x/year).

Strategic Leadership: 

• Develop and implement comprehensive revenue cycle strategies to improve financial performance and efficiency. 
• Collaborate with senior leadership and internal and external stakeholders to align revenue cycle initiatives with organizational goals.
• Functional subject matter expert – standardizing processes and documenting best practices.

Financial Performance: 

• Analyze revenue cycle financial metrics and develop action plans to address areas of improvement.
• Assist in the preparation of reports highlighting key performance indicators, financial outcomes, and staffing expenses. 

Compliance and Risk Management: 

• Interface with Compliance Officer to ensure compliance with all federal, state, and local regulations related to revenue cycle operations. 
• Implement and maintain effective internal controls to mitigate risks and ensure data integrity.

Client Onboarding and Support: 

• Collaborate with the onboarding process for new RCS BPO Clients, ensuring a smooth transition to the company’s revenue cycle management services.
• Provide ongoing support and consultation to RCS Account Leaders and Clients to enhance their revenue cycle operations and financial performance. 
• Drive documentation of best practices, accurate processes, and timely updates in SOPs.

 

Qualifications:  

• Minimum of 8 years of experience in healthcare revenue cycle management, with at least 4 years in a leadership role, preferably in an outsourcing environment. 
• Six Sigma Green Belt certified. 
• Proven track record of successfully managing and improving revenue cycle operations for multiple clients in the healthcare sector. 
• Demonstrated experience in change management.  
• Strong knowledge of healthcare billing, coding, reimbursement, and compliance regulations. 
• Excellent analytical, problem-solving, and decision-making skills. 
• Exceptional leadership and team management abilities. 
• Strong communication and interpersonal skills, with the ability to effectively interact with clients and all levels of the organization. 
• Experience working with offshore teams, particularly teams located in India and the Philippines. 
• Proficiency in revenue cycle management software and financial systems; ideally mastery of HARP, PAS, Onbase and/or other healthcare revenue cycle management systems. 
• Proficient in using Microsoft applications, BI applications, and other related software. 
• Ability to establish priorities and effectively communicate initiatives and objectives to staff. 
• Champion of change. Flexible and adaptable – willing to flex hours if needed to support client or team needs. 
• Other duties as assigned. 
• Occasional travel to client sites in the US or offshore partner locations in Asia might be requested.