Scope - This position oversees and is responsible for the National operations of an industry leading back-end insurance billing and collections department. This includes oversight of all Markets - Hospital and Physician Practice based services, through the management of people, processes, and systems and in collaboration with Market Revenue Cycle leads, IT, HR, Compliance, Internal Audit, Shared Services, Integrated Care and Coverage, Health Plan, and Medical Group leaders.
Performance - Ensures Compliant and Regulatory correct Billing with accurate and complete service capture, the highest entitled insurance reimbursement and compliant practices related to Revenue Cycle accounts receivable reimbursement recovery, adjustment posting, and credit balance management while balancing speed of operations and industry acceptable cost to deliver central services. Manages productivity and expense forecasting and capital and operating budgeting, ensuring efforts support, and are integrated into national shared service strategies.
Actively participates with Shared Services and Market Revenue Cycle leads in monitoring, reviewing, and evaluating reserve levels and the impact of current accounting practices on revenue recognition. Quantifies revenue optimization opportunities for the Markets and oversees planning and prioritization of business initiatives to effectively balance quality and cost. Accountability - This position will report and escalate to the SVP of Revenue Realization and notify / inform National, Market, KP Health Plan and other stakeholders, as appropriate.
This leader is expected to build a high-performance team achieving operational excellence in key performance areas as measured and supported by metrics. He/she also assures compliance with internal policies and State and Federal regulations. Management - Responsible for the day-to-day operations and management of people, processes and systems supporting the National accounts receivable reimbursement recovery, adjustment posting and credit balance management services.
Provides leadership through both line and matrix organizational structures supporting the revenue cycle. Provides leadership and subject matter expertise related to the development of a compliant, comprehensive revenue cycle across the Enterprise. Build a high-performance team achieving operational excellence in key performance metrics and will optimize patient service revenues assuring compliance with internal policies and State and Federal regulations.
Essential
Delivering a compliant and accurate billing, payment, remittance posting and credit balance accounts management service that balances, Accuracy (Charge Capture), Speed (AR Days), Effectiveness (Net Revenue) and Efficiency (Cost to Collect). Ensure that the revenue cycle strategy aligns with and supports the overall revenue cycle program and Kaiser Permanentes business objectives. Develop a high-performance team as measured through the achievement of benchmark process outcomes, audit and compliance results, quality goals and employee satisfaction.
Recruit and build leadership and management talent throughout the revenue cycle operation while ensuring talent has effective succession and career growth opportunities. Ensure transparency on goals and performance improvement throughout the revenue cycle process. As part of the overall Revenue Cycle leadership team, develop and implement a National strategic and operational plan for revenue cycle that aligns with the overall Program-wide plan and addresses financial performance, customer service, IT, human resources, and regulatory requirements.
Lead the program to continuously improve the revenue cycle performance through data and metrics. Monitor and provide regular reporting on key performance metrics including actual vs. expected results for financial targets, budgets, compliance, quality, customer service, and productivity/efficiency. Assist in the effort to build revenue cycle business literacy across the Markets and throughout the organization.
Lead the development of a standard business process environment for the Markets in accordance with the Program-wide strategy. Frequently and effectively communicate the revenue cycle vision and plans throughout the company. Use targeted communications that are appropriate to the various stakeholders.
Provide advice and counsel to executive leaders concerning revenue cycle issues, including regulatory and compliance, as well as industry trends. Lead effectively across matrix structures achieving high performance outcomes. Provide subject matter expertise in areas of insurance billing, denial recovery, credit balance management and adjustment posting Developing knowledge of Health Plan Key Performance Indicators including but not limited to Risk Adjustment, Medical Loss Ratios and Stars ratings Qualifications
Experience Minimum fifteen (15) years of progressive experience within the healthcare provider revenue cycle, including leadership/management experience, consulting and/or project management experience in revenue cycle design and optimization. Education Bachelors degree in healthcare administration, finance or another related field or four (4) years of experience in a directly related field required. High School Diploma or General Education Development (GED) required.
License, Certification, Registration N/A Additional
Strong expertise in provider-based revenue cycle operations and industry best practices including billing, collections & bad debt, payment processing, denial management and accounts receivable finance operations, fee schedule, documentation & coding, charge description master and charge capture. Demonstrated understanding of the operations and/or business of large healthcare systems, revenue cycle management, especially the functional areas of billing, collections & bad debt, payment processing, denial management and accounts receivable finance operations, medical records and/or patient financial services, fee schedules, documentation and coding, charge capture and health information management.
Experience in managing complex, large-scale projects and/or multiple departments and establishing detailed work plans and setting priorities. Familiarity with revenue cycle information systems and how they can be leveraged to systemize good process. Proven leadership skills in a matrix management environment that includes influencing, efficiency, collaboration, candor, and openness with a focus on results orientation.
Fifteen (15) years in consulting, Revenue Cycle services management, and or management experience in Hospital and Provider-based Revenue Cycle management. Healthcare experience in a health plan, managed care organization, medical group or hospital setting preferred. Business expertise, financial acumen, and interpersonal skills to effectively work through a matrixed, complex and political organization to influence and facilitate sustainable change.
Advanced interpersonal communication skills (written and verbal) to deal effectively with delicate, sensitive and/or complex situations with a wide variety of influential internal and external parties. Experience in leading successful large-scale business transformation initiatives. Strong, collaborative leader who can partner with multiple and geographically dispersed stakeholders to develop solutions to complex process and organizational issues.
General knowledge of Health Plan Key Performance Indicators including but not limited to Risk Adjustment, Medical Loss Ratios and Stars ratings. A Masters degree in Business Administration, Public Health, Health Administration or other related field preferred or six (6) years of work experience is preferred. Scheduled Weekly Hours: 40
Day Workdays: Mon - Fri Working Hours Start: 08:00 AM Working Hours End: 05:00 PM Job
Full-time Job Type: Standard Employee Status: Regular Worker Location: Flexible Employee Group/Union Affiliation: NUE Executives|NUE|Non Union Employee Job Level: Executive/VP Department: Po/Ho Corp - PO FIN-OFFC of the CFO - 0308
$301500 - $376875 / year Travel: Yes, 20 % of the Time