Operations [RCM]
Job Roles
We are seeking a highly experienced Senior Director / AVP Revenue Cycle Operations Excellence & Claims Reimbursement Strategy, with a focus on Robotic Process Automation (RPA) to join ourleadership team. This pivotal role will lead the strategic management and optimization of claims reimbursement processes, utilizing RPA technology to improve revenue cycle operations. The ideal candidate will have a proven track record in healthcare reimbursement, claims processing, and revenue cycle management, combined with the ability to drive technological innovation and process improvements. Excellent client engagement and presentation skills are essential for successfully communicating with clients and internal teams.
In this senior leadership role, you will work closely with clients, senior executives, and cross functional teams to streamline revenue cycle processes, optimize reimbursement practices, and implement RPA solutions. Your expertise in healthcare operations and automation will be crucial in improving claims payment efficiency, reducing denials, and enhancing overall revenue cycle performance.
Strategic Claims Reimbursement & Revenue Cycle Management:
- Oversee the entire claims reimbursement process, ensuring that claims from payers (insurance companies, government programs, etc.) are processed accurately and promptly.
- Analyze claims data to identify reimbursement trends and develop strategies to optimize claim submission, reduce denials, and improve reimbursement rates.
- Collaborate with finance, billing, and coding teams to ensure seamless claims submission, compliance with payer requirements, and financial success.
Client Engagement & Relationship Management:
- Act as the primary point of contact for clients regarding claims reimbursement and revenue cycle management, providing guidance and expertise.
- Build and maintain strong relationships with clients, ensuring their needs are met, and their expectations are exceeded.
- Present data-driven insights, process improvement strategies, and RPA implementation updates to clients and senior leadership.
- Conduct regular client meetings, deliver presentations, and communicate complex reimbursement and operational details in an understandable and actionable manner.
- Proactively identify opportunities to improve client operations, providing customized solutions and strategic advice.
RPA Strategy & Implementation:
- Lead the design and implementation of Robotic Process Automation (RPA) solutions to streamline claims reimbursement and revenue cycle functions.
- Identify opportunities to automate manual tasks and eliminate bottlenecks, reducing cycle times and improving accuracy in claims processing.
- Work with IT teams and external partners to implement and optimize RPA tools, ensuring they align with business needs and improve operational performance.
- Provide leadership and training for teams to effectively adopt RPA technologies and drive automation across revenue cycle functions.
Revenue Cycle Optimization & Process Improvement:
- Identify inefficiencies within the revenue cycle and lead initiatives to improve workflows, accelerate payment cycles, and increase revenue.
- Monitor performance metrics related to claims processing, reimbursement rates, and revenue cycle KPIs to identify opportunities for improvement.
- Collaborate with cross-functional teams to implement and sustain process improvements, leveraging RPA and other automation tools to drive efficiency and reduce costs.
- Stay up-to-date with healthcare industry trends, payer policies, and regulatory changes to ensure the revenue cycle is in compliance and optimized.
Leadership & Team Collaboration:
- Lead, mentor, and develop a high-performing team focused on revenue cycle management, claims reimbursement, and RPA implementation.
- Work closely with senior management and other departments to align revenue cycle strategies with broader organizational goals and drive company-wide performance improvements.
- Foster a culture of innovation, continuous improvement, and collaboration across teams, ensuring the successful adoption of new technologies and strategies.
Client Presentations & Reporting:
- Develop and deliver strategic presentations and reports for clients, detailing revenue cycle performance, claims reimbursement trends, and recommendations for process improvements.
- Clearly communicate complex data and solutions, offering actionable insights to help clients enhance their operational efficiencies and revenue outcomes.
Candidate Requirements
Education:
- Bachelor’s degree, or a related field (Master’s degree preferred).
Experience:
- Minimum of 8-10 years of experience in revenue cycle management, claims reimbursement, and healthcare operations, with at least 5 years in a leadership or senior management role.
- Proven experience with RPA technologies (e.g., UiPath, Automation Anywhere, Blue Prism) and a strong ability to implement automation solutions to improve business processes.
- Strong background in client engagement, relationship management, and delivering client presentations.
- Expertise in healthcare billing systems, EHR, and claims processing systems.
Skills & Competencies:
- Excellent communication and presentation skills, with the ability to explain complex data and technical concepts to both clients and non-technical stakeholders.
- Proven ability to build and sustain client relationships and successfully manage client expectations.
- Exceptional leadership and team management skills, with the ability to inspire, coach, and develop high-performing teams.
- Strong analytical skills with a focus on driving actionable insights from data.
- Knowledge of payer requirements, insurance regulations, and healthcare revenue cycle operations.
- Ability to lead change and drive process improvements across a large, complex organization.