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DescriptionThe Corporate Director of Revenue Optimization is responsible for leading and executing strategies that maximize revenue capture, ensure accurate charge capture, and optimize pricing strategies across both Hospital-Based (HB) and Professional Billing (PB) settings.
This role also oversees the development and management of governmental healthcare managed care contracts and collaborates with various departments to ensure successful implementation of healthcare projects.
The ideal candidate will possess deep expertise in revenue cycle management, charge description master (CDM) management, and healthcare analytics to drive financial performance and compliance.
Key Responsibilities:
1.Revenue Optimization:
Develop and implement revenue optimization strategies to maximize financial performance across all service lines. Oversee the analysis of revenue cycles to identify areas for improvement and recommend corrective actions.Collaborate with clinical and operational teams to ensure revenue opportunities are fully captured.2. Charge Capture & CDM Management:
Ensure accurate charge capture processes in both HB and PB settings to prevent revenue leakage. Oversee the management and maintenance of the Charge Description Master (CDM) for all services, ensuring compliance with regulatory and payer requirements.Implement audits and controls to monitor and improve charge capture accuracy and compliance.3. Managed Care Contracts:
Lead the management, and analysis of governmental healthcare managed care contracts. Ensure that contracts align with the organizations financial goals and compliance requirements.Analyze contract performance and recommend strategies for improvement.4. Pricing Strategy Analytics & Analysis:
Develop and oversee pricing strategies to ensure competitive and compliant pricing models. Conduct comprehensive financial and data analysis to support pricing decisions and contract negotiations.Collaborate with finance and operational teams to ensure pricing strategies align with overall organizational goals.5. Healthcare Implementation Projects:
Lead and manage the implementation of healthcare projects, ensuring they are delivered on time, within scope.Collaborate with IT, finance, operations, and clinical teams to implement systems and processes that support revenue optimization and charge capture.Monitor project performance and implement corrective actions as needed.6. Leadership & Collaboration:
Provide leadership and guidance to revenue cycle, CDM, and contracting teams. Collaborate with senior leadership to align revenue optimization strategies with overall organizational goals.Foster a culture of continuous improvement and professional development within the team.7. Compliance & Regulatory Oversight:
Ensure compliance with all federal, state, and local regulations related to revenue cycle management, charge capture, and managed care contracts.Stay informed on regulatory changes and implement necessary adjustments to policies and procedures.
MINIMUM QUALIFICATIONS:
Education:
Bachelor's degree in Healthcare Administration, Business Administration, Finance, or a related fieldMinimum of 10 years of experience in revenue cycle management, charge capture, CDM, and/or managed care contracts in a healthcare setting.PREFERRED QUALIFICATIONS:
Education -
Master's degree in Healthcare Administration, Business Administration, Finance, or a related field
SKILLS:
Extensive knowledge of governmental healthcare managed care contracts and pricing strategies. Strong analytical skills with experience in healthcare pricing strategy analytics and data analysis. Proven track record of leading successful healthcare implementation projects. Excellent leadership, communication, and collaboration skills.Proficiency in healthcare revenue cycle software and analytics tools.Knowledge of compliance and regulatory requirements in healthcare finance. Work Environment:
This role may require occasional travel to various healthcare facilities and offices.
The position is typically based in a corporate office setting with regular interaction with senior leadership and various departments. This job description is intended to provide a general overview of the responsibilities and requirements of the position.
It is not intended to be exhaustive or exclusive. Duties, responsibilities, and activities may change based on organizational needs.
Additional DetailsQualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law.
ACCOMMODATIONS: EHC will provide reasonable accommodation to qualified individuals with disabilities upon request. To request this document in an alternate format or to request a reasonable accommodation, please contact the Office of Leave and Accommodations.
PHYSICAL REQUIREMENTS: (Medium-Heavy) 36-75 lbs., 0-33% of the work day (occasionally); 20-35 lbs., 34-66% of the workday; (frequently); 10-20 lbs., 67-100% of the workday (constantly); Lifting 75 lbs. max; Carrying of objects up to 35 lbs.; Occasional to frequent standing & walking; Occasional sitting; Close eye work (computers, typing, reading, writing); Physical demands may vary depending on assigned work area and work tasks.
ENVIRONMENTAL FACTORS: Factors affecting environmental conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure; Bio-hazardous waste Chemicals/gases/fumes/vapors; Communicable diseases; Electrical shock; Floor Surfaces; Hot/Cold Temperatures; Indoor/Outdoor conditions; Latex; Lighting; Patient care/handling injuries; Radiation; Shift work; Travel may be required; Use of personal protective equipment, including respirators; environmental conditions may vary depending on assigned work area and work tasks.
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