Vice President of Revenue Cycle Operations - Payers Escalation

$165,976 - $249,612/Yr

R1 RCM - Detroit, MI

Full-time - Senior

Detroit, MI

10,001+ employees

Professional, Scientific, and Technical Services

About the position

As the Vice President of Revenue Cycle Operations - Payers Escalation at R1 RCM, you will play a pivotal role in overseeing and enhancing the payer escalation process within our revenue cycle management (RCM) operations. This position requires a strategic leader who possesses extensive experience in revenue cycle management, payer relations, and dispute resolution. You will be expected to work closely with senior leaders to optimize payer performance, resolve escalated issues efficiently, and drive revenue integrity across the organization. Your leadership will be crucial in developing and implementing strategies that improve payer escalation processes, ensuring that our operations align with organizational goals. In this role, you will establish and maintain strong relationships with key payers, negotiating resolutions for escalated issues while monitoring and analyzing payer performance to identify trends that impact revenue. You will also be responsible for analyzing and optimizing existing payer escalation processes, implementing best practices and innovative solutions to enhance efficiency and effectiveness. Compliance with industry regulations and standards throughout the escalation process will be a key focus area. Utilizing data analytics, you will identify patterns and root causes of payer-related issues, preparing and presenting reports on payer performance and escalation outcomes to senior leadership. You will develop and monitor key performance indicators (KPIs) related to payer escalation, ensuring that our strategies are data-driven and effective. Collaboration is essential in this role, as you will work closely with internal departments such as billing, coding, and compliance to address payer-related issues. Maintaining clear and effective communication with payers, providers, and internal stakeholders will be vital. Additionally, you will provide training and support to staff on best practices in payer escalation processes, fostering a culture of continuous improvement and excellence within the team.

Responsibilities

• Develop and implement strategies to improve payer escalation processes.
• Lead and mentor a team of RCM professionals focused on payer escalation.
• Collaborate with senior leadership to align payer escalation strategies with organizational goals.
• Establish and sustain strong relationships with key payers.
• Negotiate resolutions for escalated issues.
• Monitor and analyze payer performance, identifying trends impacting revenue.
• Analyze and optimize existing payer escalation processes.
• Implement best practices and innovative solutions to enhance efficiency and effectiveness.
• Ensure compliance with industry regulations and standards throughout the escalation process.
• Utilize data analytics to identify patterns and root causes of payer-related issues.
• Prepare and present reports on payer performance and escalation outcomes to senior leadership.
• Develop and monitor key performance indicators (KPIs) related to payer escalation.
• Work closely with internal departments, such as billing, coding, and compliance to address payer-related issues.
• Maintain clear and effective communication with payers, providers, and internal stakeholders.
• Provide training and support to staff on best practices in payer escalation processes.

Requirements

• Minimum of 10 years of experience in revenue cycle management, with a focus on payer relations and escalation.
• In-depth knowledge of healthcare regulations and payer policies.
• Proven leadership experience, with the ability to manage and motivate a team.
• Strong and broad understanding of Revenue Cycle Operations within a hospital setting.
• Strategic vision and operational excellence across end-to-end solutions.
• Exceptional negotiation and problem-solving skills.
• Excellent communication and interpersonal abilities.
• Proficiency in data analysis and reporting tools.

Benefits

• Competitive benefits package including health insurance, dental insurance, and vision insurance.
• Opportunities for professional development and career growth.
• Flexible work arrangements and a supportive work environment.