Vice President of Revenue Cycle & Managed Care

Vice President Of Revenue Cycle & Managed Care

Adventist HealthCare seeks to hire an experienced Vice President of Revenue Cycle & Managed Care who will embrace our mission to extend God's care through the ministry of physical, mental, and spiritual healing. The Vice President of Revenue Cycle & Managed Care provides executive oversight of all functions governing the health system's end-to-end revenue performance. This leader is responsible for the strategic development, negotiation, and administration of payer contracts while simultaneously directing the operational functions of patient access, coding, billing, collections, and denial management. The VP ensures that what is negotiated at the contracting table is effectively realized at the billing and collections level, creating a cohesive revenue strategy that supports the organization's financial sustainability, operational efficiency, and value-based transformation goals.

As a Vice President of Revenue Cycle & Managed Care, you will:

• Develop and implement strategies to optimize the end-to-end revenue cycle for ambulatory services.
• Oversee billing, coding, collections, and reimbursement processes to ensure accuracy and efficiency.
• Monitor key performance indicators (KPIs) and implement improvements to enhance financial performance.
• Collaborate with clinical and administrative staff to streamline workflows and reduce denials and write-offs.
• Lead and mentor a team of revenue cycle and managed care professionals.
• Foster a culture of continuous improvement, accountability, and collaboration.
• Provide regular training and development opportunities for team members.
• Ensure compliance with all federal, state, and local regulations related to revenue cycle and managed care.
• Develop and implement policies and procedures to mitigate risk and ensure ethical billing practices.
• Prepare and present regular reports on revenue cycle performance.
• Conduct financial analysis to identify trends, opportunities, and areas for improvement.
• Develop and manage the department budget, ensuring alignment with organizational.
• Lead the development and execution of the health system's managed care strategy across all payer segments, including commercial, Medicare Advantage, Medicaid managed care, and self-insured employers.
• Direct the negotiation of all facility, professional, and ancillary contracts with commercial and government payers, ensuring competitive rates and operationally executable terms.
• Develop and maintain robust contract financial models to evaluate the revenue impact of proposed rate structures, reimbursement methodologies, and risk-sharing arrangements.
• Leverage revenue cycle performance data including denial rates, underpayments, and claims adjudication patterns to directly inform and strengthen contract negotiation positions.
• Maintain a comprehensive payer contract calendar and ensure timely renewals, amendments, renegotiations, and termination notices across all payer agreements.
• Serve as the senior executive liaison with payer network directors, medical directors, and government program administrators.
• Monitor market benchmarking data, competitor rate intelligence, and payer financial performance to sharpen negotiation strategy and identify new contracting opportunities.
• Stay current with industry trends, regulations, and best practices.

Qualifications include:

• Excellent communication and negotiation skills, both written and verbal.
• Strong knowledge of revenue cycle best practices.
• In-depth knowledge of reimbursement methodologies, insurance regulations, and industry trends.
• Strong financial acumen and ability to analyze complex financial data and make data-driven decisions.
• Strong organization skills with the ability to prioritize and manage multiple projects simultaneously.
• Customer and relationship-focused, and results-oriented.
• Bachelor's degree in healthcare administration, business administration, or a related field. Master's degree preferred.
• Extensive experience (10 years) in healthcare revenue cycle covering multiple functions within the revenue cycle. Extensive knowledge of ambulatory services.
• 5 years of leadership role overseeing revenue cycle functions.