Vice President of Revenue Cycle Management - Framingham, Massachusetts, United States

Overview · Salary: $160,000-$180,000 · The Vice President of Third-Party Revenue Cycle Management leads the strategic development, execution, and oversight of revenue cycle initiatives to maximize financial performance. This executive collaborates with Finance and Service Line Di ...

Job description

Overview

Salary: $160,000-$180,000

The Vice President of Third-Party Revenue Cycle Management leads the strategic development, execution, and oversight of revenue cycle initiatives to maximize financial performance. This executive collaborates with Finance and Service Line Divisions to optimize clinical and financial processes, ensuring alignment with organizational goals. This role requires expertise in planning, implementing, and managing Revenue Cycle Management (RCM) strategies, with a focus on enhancing revenue outcomes and streamlining interdependent functions across the enterprise.

This is a hybrid position. Monday through Friday 8am-5pm 

Minimum Education Required

Bachelor's Degree

Responsibilities

1. Develop and execute a comprehensive revenue cycle strategy aligned with organizational goals, including clearly defined metrics to improve timeliness, accuracy and overall collection rates of claims.
2. Direct all day-to-day revenue cycle functions, including claims submission, payment posting, and patient collections. Woth with service line leadership on optimizing registration, insurance authorization and verification.
3. Collaborate with service line leadership on financial forecasting and revenue optimization.
4. Utilize data-driven insights to identify trends, forecast revenue, and inform decision-making.
5. Set, track, and report on key performance indicators (KPIs) such as days in accounts receivable (A/R), denial rates, and collection percentages to drive continuous improvement.
6. Manage and negotiate contracts with commercial insurance carriers and government payers, such as Medicare and Medicaid, to optimize reimbursement rates.
7. Build, train, and manage a high-performing revenue cycle team. Foster a culture of accountability and professional growth within the department.
8. Ensure all RCM activities adhere to federal, state, and payer-specific regulations, including HIPAA. Identify and mitigate potential risks that could impact the organization.
9. Develop and implement processes to identify root causes of denials, prevent future rejections, and manage appeals to minimize revenue loss.
10. Develop and ensure implementation of policies, guidelines, and procedures as they relate to the RCM process.
11. Monitor effectiveness of activities, ensuring that outstanding authorizations, billings, postings, collections and accounts receivables are within established time limits and that bad debt is within industry standards by conducting routine concurrent and retrospective audits.
12. Enhance and standardize workflows. Develop and implement billing practices by leveraging technology to automate, and standardize processes.
13. Conduct regular meetings with the team to ensure implementation of all RCM plans, programs, and projects are adhering to deadlines
14. Conduct regular meeting with the Enterprise Applications Team to support refinement and development of third party billing software system.
15. Design/develop training programs for development of technical competencies of the team.
16. Manage the authorization/billing/collection staff in handling patient/payer relations and handles complex complaints and issues.
17. Stay abreast of third-party payer billing guidelines and communicate these changes to all interested parties.
18. Ensures all service fee schedules are correctly loaded in the system, billed correctly and reimbursed at the rates agreed.
19. Attends and actively participates in supervision and staff meetings
20. Adhere to all principles related to the Advocates Way
21. Ensure that clients are treated with dignity and respect in accordance with Advocates' Human Rights Policy.
22. Performs all duties in accordance with agency's policies and procedures.
23. Strictly follow all agency Performance Standards

Qualifications

1. Bachelor's degree in healthcare administration, finance, or a related field, or equivalent experience.
2. Minimum 15 years of healthcare billing experience, including at least 10 years managing teams of individual contributors and managers.
3. Industry certifications, such as those through Healthcare Financial Management Association, the American Health Information Management Association, or the Academy of Professional Coders, preferred.
4. Strong, in-depth knowledge of revenue cycle management principles and practices, including, collections, managed care products, regulatory compliance, payer credentialing, and financial reporting related to behavioral health billing.
5. Extensive knowledge of behavioral health billing processes.
6. Strong experience with electronic health records (EHRs) and integrated RCM modules.
7. Demonstrated success working with diverse payer mixes, with a focus on Medicaid and Managed Medicare payers, and varied reimbursement methodologies.
8. Proven experience supporting new product launches and integrating associated billing requirements.
9. Strong organizational, leadership, and interpersonal skills.
10. Ability to analyze complex workflows and implement process improvements that enhance efficiency and outcomes.
11. Demonstrated ability to hire, mentor, and develop high‑performing teams.
12. Excellent written and verbal communication skills with the ability to engage all levels of internal and external stakeholders.
13. High energy, strong interpersonal presence, and ability to work effectively both independently and as part of a team.
14. Proven ability to delegate, prioritize, and meet strict deadlines.
15. Strong analytical and organizational skills with the ability to apply varied decision‑making frameworks.
16. Must be able to perform each essential duty satisfactorily.

Advocates is committed to cultivating a diverse and welcoming community where everyone feels respected and valued. Advocates fosters a culture of inclusion that celebrates and promotes diversity along multiple dimensions, including race, ethnicity, sex, gender identity, gender expression, sexual orientation, partnered status, age, national origin, socioeconomic status, religion, ability, culture, and experience.