Executive Director, Enterprise Billing Strategy, Bureau of Office of Chief Medical Officer

Job Description

The Office of the Chief Medical Officer (CMO) launched in 2021 to facilitate collaboration and coordination among healthcare delivery partners and the Health Department around a shared vision for improving health in New York City. The CMO Office mission is to develop and implement anti-racist policies and programs in three key areas: Provider Communications and Engagement; Cross-Agency Clinical Coordination and Management; and Workforce Sustainability. Within this mission, revenue generation is not a back-office finance function but the mechanism that makes New York City's community health workforce financially durable: by converting community-based services into reimbursable care, the Department can sustain community health workers, doulas, peer specialists

Office of the Chief Medical Officer is seeking to hire an Executive Director of Enterprise Biling Strategy and Healthcare Access.

DUTIES WILL INCLUDE BUT NOT BE LIMITED TO:

- Build Medicaid Biling Infrastructure from Design to First Revenue. The Executive Director must bring a demonstrated, hands-on track record of personally standing up billing infrastructure for non-traditional provider types community health workers, doulas, peer specialists, and health educators in a Medicaid-dominant payer environment, from initial design through first revenue generation, with measurable financial results. This is the central requirement of the role. The successful candidate has built such an operation before and can speak in specifics about how they did it and what it produced.

- Manage the Ful Revenue Cycle. The Executive Director has the ability to lead a team of experts across divisions to oversee the complete revenue cycle lifecycle: charge capture, coding, claims submission, clearinghouse and EHR/billing-system configuration, denials and accounts receivable management, and revenue reporting. The role requires demonstrable fluency with electronic health record and claims systems, clearinghouses, and denials-management workflows, and the ability to partner credibly and at a technical level with the Department's technology staff and vendors.

- Architect the Documentation-to-Claims Pipeline. The Executive Director leads a team of experts across divisions and builds the data flow that turns point-of-service documentation into clean, billable claims configuring community health worker documentation platforms and EHR builds so that the encounter, the eligibility data, the coding, and the claim move through one coherent pipeline.

- Negotiate and Manage Medicaid Managed Care Contracts to Closure. The Executive Director has hands-on experience negotiating with Medicaid managed care organizations and a record of closing payer agreements that produced consistent reimbursement revenue. The role requires positioning a public health entity as a credible Medicaid billing provider and building and managing a sustainable portfolio of MCO contracts across New York City's Medicaid managed care landscape.

- Own the Revenue Target, Manage Vendors and Partner with Finance to Enhance the Revenue-Cycle Team. The Executive Director owns a revenue target for non-traditional provider types and is accountable for its financial performance. The role includes managing the vendors that support documentation, claims and billing for non-traditional provider types and partnering with Bureau of - Revenue to enhance the revenue cycle unit to accommodate non-traditional provider-type billing.

- Operational Leadership and Near-Term Delivery. The Executive Director is an exceptionally organized operator who drives concurrent workstreams to completion on hard deadlines. Near-term deliverables include achieving first Medicaid revenue by early 2027, executing managed care contracts with a target set of plans within the first year, and standing up claims operations at a defined volume.

Why you should work for us:

- Loan Forgiveness: As a prospective employee of the City of New York, you may be eligible for federal/state loan forgiveness and repayment assistance programs that lessen your payments or even fully forgive your full balance. For more information, please visit the U.S. Department of Education’s website (https://studentaid.gov/pslf/)
- Benefits: City employees are entitled to unmatched benefits such as:
o a premium-free health insurance plan that saves employees over $10K annually, per a 2024 assessment.
o additional health, fitness, and financial benefits may be available based on the position’s associated union/benefit fund.
o a public sector defined benefit pension plan with steady monthly payments in retirement.
o a tax-deferred savings program and
o a robust Worksite Wellness Program that offers resources and opportunities to keep you healthy while serving New Yorkers.
- Work From Home Policy: Depending on your position, you may be able to