Director, Revenue Cycle Market Operations

Role Description

Functions as a revenue cycle operations and relationship leader based in local market facilities to help coordinate and communicate across system revenue cycle and local market needs. Builds relationships and coordinates with various departments across the market(s) and Adventist Health shared services, including but not limited to:

• Patient access
• Care management
• Clinical departments
• Physicians
• Finance
• Coding
• Patient financial services

Identifies opportunities and improves revenue cycle performance. Facilitates various revenue cycle performance meetings for their assigned market(s) to:

• Review key system and market performance metrics and trends
• Provide and/or facilitate status updates on key market improvement initiatives
• Develop action plans
• Facilitate clear communication on system versus market ownership and accountability

Operates as the market subject matter expert for revenue cycle, focusing on:

• Market performance
• Market-driven dependencies that impact cash collections
• Accounts receivable
• Uncompensated care
• Denials
• Service capture
• Avoidable rework
• Other revenue cycle opportunities

Manages the shared accountability for system standard performance metrics, with individual goals developed based on market specific current state performance. Shares local learnings with other market revenue cycle market operations leadership.

Qualifications

• Bachelor’s Degree or equivalent combination of education/related experience: Required
• Master's Degree: Preferred
• Seven years' related experience: Preferred
• Five years' leadership experience: Preferred

Requirements

• Communicates metrics, performance, initiatives, dependencies to market financial officers, and from local market financial officer to revenue cycle leadership with concerns, priorities, and other market updates.
• Provides project management for system initiatives in the local market where market-based dependencies are present.
• Escalates market-based negative performance impacts when they differ from or have not been identified by system initiatives.
• Partners and leads performance improvement initiatives as needed to achieve revenue cycle related goals.
• Serves as revenue cycle subject matter expert of their local market(s) - trends, history, regulatory, etc.
• Builds and maintains relationships with the local market leadership and staff, including but not limited to finance, patient access, care management, clinical documentation specialists, department leaders, and physicians.
• Collaborates effectively with market leadership and staff.
• Helps manage market performance by acting as a coordination and collaboration point between system revenue cycle and assigned local market(s).
• Understands system revenue cycle trends and extrapolates them to local revenue cycle opportunities through data analytics, process observations, staff interactions, and account reviews.
• Analyzes market revenue cycle data to identify further market-specific opportunities and root causes.
• Partners with appropriate stakeholder(s) to improve performance.
• Manages performance against established revenue cycle performance metrics, including but not limited to cash, accounts receivable, denials, avoidable losses, and cost-to-collect.
• Collaborates with corporate shared services to drive performance improvement and helps to implement initiatives in local market(s).
• Facilitates various, recurring revenue cycle performance meetings with key market and revenue cycle stakeholders.
• Meets regularly with the market financial officer(s).
• Acts as project manager for revenue cycle opportunities identified through regular performance meetings and helps implement improvements.
• Monitors market work queues and other work-in-process.
• Monitors market revenue and usage trends, coordinating with revenue integrity on solution implementation.
• Helps provide market staff, clinician, and physician education pertaining to revenue cycle opportunities.
• Escalates payer revenue cycle issues through defined managed care escalation process.
• Escalates system optimization opportunities through defined IT governance and escalation process.
• Collaborates with market leadership to help achieve strategic and performance goals.
• Maintains current knowledge base of regulations and insurance contracts.
• Communicates revenue cycle performance to market(s), and vice-versa, and helps knowledge share across markets.
• Helps execute overall strategic goals locally.
• Performs other job-related duties as assigned.

Benefits

• Adventist Health is committed to the safety and wellbeing of our associates and patients.
• All associates are required to receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
• Adventist Health participates in E-Verify.