VP of Revenue Cycle Management

Description

Vice President of Revenue Cycle Management (RCM)

Department: Revenue Cycle Management

Reports To: Senior Vice President (SVP) of Revenue Cycle Management

Position Summary:

The Vice President of Orthopedic Revenue Cycle Management is responsible for the strategic leadership, operational performance, and financial outcomes of the orthopedic revenue cycle across all service lines. This executive leader will oversee the full lifecycle of orthopedic and musculoskeletal claims, including surgical, procedural, ancillary, clinical, and professional billing services.

The VP will build, develop, and lead a high-performing orthopedic RCM team responsible for maximizing reimbursement, reducing denials, improving cash collections, ensuring regulatory compliance, and driving operational excellence throughout the revenue cycle. This role serves as the orthopedic subject matter expert for revenue cycle strategy and collaborates closely with clinical operations, physician leadership, coding, billing, credentialing, contracting, and finance teams.

Essential Responsibilities

Strategic Leadership

• Develop and execute the orthopedic revenue cycle strategy in alignment with organizational goals.
• Establish performance standards, workflows, and accountability measures for all orthopedic RCM functions.
• Identify opportunities to improve reimbursement, reduce leakage, and optimize financial performance.
• Partner with executive leadership to develop long-term revenue cycle initiatives and growth strategies.
• Provide regular reporting and analytics to executive leadership regarding revenue cycle performance and trends.

Full Revenue Cycle Oversight

Provide oversight and accountability for all aspects of orthopedic revenue cycle operations, including:

• Charge capture and charge reconciliation
• Coding and documentation review
• Surgical billing and reimbursement optimization
• Prior authorization management
• Claim submission and claim edits
• Payment posting and reconciliation
• Denial prevention and denial management
• Appeals and underpayment recovery
• Accounts receivable management
• Patient financial services and collections
• Contract reimbursement analysis
• Revenue integrity initiatives
• Compliance with payer regulations and billing requirements

Orthopedic Surgical Revenue Management

• Oversee revenue cycle processes for orthopedic surgical procedures, ambulatory surgery centers, office-based procedures, imaging, DME, physical therapy, and ancillary services.
• Ensure accurate capture and billing of complex surgical cases.
• Monitor and improve reimbursement for operative services, implant-related procedures, injections, regenerative medicine services, diagnostics, and specialty programs.
• Partner with physicians and clinical teams to enhance documentation supporting reimbursement.

Denials and AR Management

• Develop aggressive denial prevention and recovery strategies.
• Monitor denial trends by payer, provider, location, procedure, and service line.
• Establish action plans to reduce aging AR and improve collection rates.
• Lead payer dispute resolution and escalation efforts when necessary.
• Ensure timely appeal submission and follow-through.

Team Development & Leadership

• Build and structure a specialty orthopedic RCM department capable of supporting organizational growth.
• Recruit, hire, train, mentor, and retain high-performing team members.
• Develop leadership succession plans and career development pathways.
• Conduct ongoing coaching, performance management, and staff development.
• Foster a culture of accountability, continuous improvement, and operational excellence.

Operational Performance

• Establish and monitor key performance indicators (KPIs) including:
• • Net Collection Rate
  • Days in Accounts Receivable
  • Clean Claim Rate
  • Denial Rate
  • First Pass Resolution Rate
  • Surgical Collection Yield
  • Cash Collections
  • Bad Debt Percentage
  • Patient Collection Metrics
  • Payer Performance Indicators
• Lead process improvement initiatives utilizing data-driven decision making.
• Implement automation and technology solutions to improve efficiency and scalability.

Compliance & Regulatory Oversight

• Ensure compliance with all federal, state, payer, and contractual billing requirements.
• Maintain working knowledge of Medicare, Medicaid, Commercial Insurance, Workers' Compensation, and Personal Injury reimbursement methodologies.
• Collaborate with compliance teams on audits, investigations, and corrective action plans.
• Ensure proper implementation of coding and documentation guidelines.

Required Qualifications

Education

• Bachelor's Degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field required.
• Master's Degree preferred.

Experience

• Minimum 10 years of progressive healthcare revenue cycle leadership experience.
• Minimum 5 years managing orthopedic or surgical revenue cycle operations.
• Demonstrated success leading multi-function RCM teams.
• Extensive experience with orthopedic surgical billing and reimbursement methodologies.
• Proven experience improving cash collections, reducing denials, and increasing operational efficiency.
• Experience managing physician practice revenue cycles, surgical services, ancillary services, and specialty billing operations.

Knowledge & Skills

• Deep understanding of orthopedic practice operations and reimbursement.
• Advanced knowledge of revenue cycle workflows and best practices.
• Strong understanding of CPT, ICD-10, HCPCS, modifier utilization, and payer policies.
• Expertise in denial management and AR optimization.
• Financial analysis and reporting proficiency.
• Strong leadership, coaching, and team-building capabilities.
• Exceptional communication and executive presentation skills.
• Ability to lead organizational change and process improvement initiatives.

Performance Expectations

Success in this role will be measured by:

• Increased cash collections and revenue realization
• Reduction in denied claims and denial write-offs
• Improved clean claim submission rates
• Improved AR aging performance
• Achievement of KPI targets established by executive leadership
• Successful development and retention of orthopedic RCM staff
• Increased reimbursement accuracy and compliance
• Implementation of scalable processes supporting organizational growth
• Strong physician and operational stakeholder satisfaction

Leadership Competencies

• Strategic Thinking
• Financial Acumen
• Accountability
• Team Development
• Operational Excellence
• Change Management
• Data-Driven Decision Making
• Cross-Functional Collaboration
• Continuous Improvement
• Results Orientation

Background Check Requirement: Employment is contingent upon the successful completion of a background check, which may include verification of employment history, education, criminal records, and other relevant information as permitted by law