Emerus

VP of Revenue Integrity

US-TX-The Woodlands
4 weeks ago
ID
2017-6334
Emerus Holdings Inc
Type
Full-Time
Shift Type
Days

About Us

Emerus is the nation's first and largest operator of micro-hospitals. Emerus partners with leading health systems to provide excellence, empathy and innovation in health care delivery through a network of efficient, value-based micro-hospitals. The Emerus network brings high-quality, patient-centric acute episodic and ambulatory clinical services to communities across a given market. This helps patients by positioning best-in-class provider services in the communities where they work, live and play. Emerus' distinctive level of care earned the Guardian of Excellence Award for Superior Patient Experience in 2013, 2014, 2015 and 2016. More information is available at www.emerus.com.

Position Overview

Emerus is on a tremendous growth path. Emerus’ footprint will grow from 16 micro-hospitals in two states at the start of 2017 to over 30 facilities across 7 states and 10+ markets in the next two years. In addition to supporting this growth, Emerus seeks to build a world-class revenue capture engine that maximizes collections and is responsive to changing healthcare industry dynamics such as higher patient deductibles and care liability, payer utilization management and modernization of traditional Revenue Cycle Management (RCM) operations.  This position will partner with the head of the central billing office and will report directly to the Chief Financial Officer.

Essential Job Functions

The VP, Revenue Integrity will be responsible for maximizing cash, revenue capture and integration of the business. This includes establishing a baseline for every dollar Emerus clinical services should generate and ensuring maximum realization (i.e., minimum leakage) and speed of collections. In addition to working with the leader of the Central Billing Office, this responsibility will include management and influence over other revenue drivers such as: contract yield estimation, appropriate clinical documentation and charge capture, payer denials/under-payment management, point of service collections at Emerus micro-hospital (in partnership with operations chain of command), and influence of payer contact negotiations. S/he will provide strategic leadership across departments to realize the objectives and will have responsibility for development, implementation and management of an end-to-end revenue maximization strategy with the following goals:

  • Establish a baseline for measuring what revenue each visit should generate based on contract terms and clinical services. Measure and improve performance against this baseline over time.
  • Develop and maintain Charge Capture Key Performance Indicators (KPI) in accordance with industry best practices and expert knowledge.
  • Review and analyze current billing systems for optimization and reporting with influence on future system selections and implementations.
  • Organize and Manage disparate data sources utilized within and between hospital entities.
  • Identify all sources of revenue leakage across the clinical care and billing operations processes
  • Develop and implement strategies to minimize sources of revenue leakage. Establish a process to measure these sources of leakage and report performance over time.  Drive process improvements across all RCM functions.
  • Develop a patient collections strategy including point of service (working with operations), CBO collections and aged A/R strategy.
  • Charge capture and controls. Develop processes for documentation capture of all clinical services performed and management of clinical employees against objective goals
  • Maximize and accelerate cash collections
  • Partner effectively with business and clinical operations leadership in the field to achieve goals
  • Partner effectively with 3rd-party vendors to achieve optimal results and best ROI
  • Develop robust reporting packages and metrics across RCM effectiveness, efficiency and quality. Ensure performance expectations are measured and reported through a timely and transparent system of metrics. Set goals for performance and improvement that are informed by external benchmarks
  • Standardize and operationalize reporting packages and metrics to be consistent, reliable, accurate, relevant, and timely.
  • Monitor, analyze and stay current with innovative tools and trends in hospital and physician collections management and related reimbursement issues

Basic Qualifications

The VP, Revenue Capture will be a talented healthcare executive with at least 10 years of progressive experience in healthcare revenue cycle and operations activities, with exposure to payer contracting and patient collections dynamics. Experience in a complex healthcare environment is essential and experience working across state lines with different partners is preferred. S/he must demonstrate a comprehensive understanding of the entire physician and hospital revenue cycle, from contracting and pre-encounter steps through cash collections and AR management. S/he will have a proven track record and demonstrate an understanding of current trends and innovations being brought to healthcare revenue realization. S/he will be a creative and strategic leader who can drive change through influence with other upstream areas of the business.

Other desired experiences include:

  • Experience in hospital revenue cycle is primary; physician revenue cycle is preferred but not a requirement
  • Experience with EMR and Revenue Cycle IT systems, particularly leading platforms like Epic and Cerner
  • A collaborative, influential team player with proven ability to work with and influence hourly, salary, and senior leaders of an organization
  • Knowledge of governing regulations and standards relating to healthcare billing, collections, customer service and registration
  • Strong quantitative and analytical skills as well as the ability to manage multiple projects while maintaining performance of on-going business processes
  • Proficient in managing and analyzing large, disparate data sets
  • Proven process improvement track record
  • Proactive mindset with an inherent bias towards continuous improvement

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