Valor Health · 1 day ago
REVENUE CYCLE MANAGER
Emmett, ID
Full-time
Onsite
Senior Level, Lead/Staff
8+ years expValor Health is seeking a Revenue Cycle Manager responsible for optimizing billing, collections, and reimbursement processes while ensuring compliance with regulations. The role involves overseeing day-to-day revenue cycle functions, developing strategies to prevent denials, and collaborating with various departments to enhance financial performance.
CommunitiesHealth CareHospital
Responsibilities
Develop strategic plans and programs for the Revenue Cycle team and ensure goals and objectives are properly defined and clearly established
Provide or ensure the correct technical expertise related to CPT (Current Procedural Terminology) and ICD-10 (International Classification of Diseases) coding, with preparation for ICD-11 adoption
Oversight of the Chargemaster, including maintaining a system to track, revise, and update with the appropriate CPT and ICD-10 codes for accurate and timely charging of services
Develop and utilize quality improvement tools to measure billing accuracy and efficiency. Address areas of concern identified from such efforts and report to the CFO
Provide training for all Valor providers and appropriate staff on changes or updates to coding and billing practices for Critical Access Hospitals
Assure compliance with HIPAA privacy and security standards, the No Surprises Act, the CMS Hospital Price Transparency Rule, Medicare Advantage authorization requirements, and other applicable federal and state billing regulations
Maintain strong relationships with insurance companies; identify and resolve issues that may slow cash flow (denial trends, new insurance plans, new providers, or network changes)
Drive net revenue integrity by ensuring accurate charge capture, timely reimbursement, effective patient collections, and proactive bad debt reduction strategies that safeguard the financial health of the organization
Review and evaluate the performance of the team on a regular basis and ensure overall performance remains within pre-established goals and objectives
Serve as the organizational subject matter expert on revenue cycle operations, payer relations, and reimbursement policy, advising leadership on regulatory shifts and payer trends
Lead proactive denial prevention strategies and ensure claims are submitted accurately and timely with first-pass acceptance goals in mind
Partner cross-functionally with Finance, Operations, IT, and clinical leadership to ensure revenue cycle processes are aligned with broader system strategy and patient care priorities
Collaborate with IT and Data teams to implement automation, identify process bottlenecks, and uncover trends in revenue behavior that inform forecasting and strategy
Guide revenue cycle staff through change initiatives, providing mentorship, structure, and clear communication during transitions
Ensure audits are completed in all areas of the Revenue Cycle (registration accuracy, billing, coding, regulatory compliance, payer audits, etc.) and appropriate follow-up and education take place
Regularly report performance to the CFO and other leadership, using dashboards that include but are not limited to: Days in Accounts Receivable (AR) by payer class, Clean claim rate and first-pass acceptance rate, Denial and avoidable write-off rates, Discharged Not Final Billed (DNFB) days, Patient pay collections and financial clearance rates, Patient financial experience scores tied to billing and collections
Actively research revenue cycle best practices, benchmark performance, and implement process improvements that align Valor Health with leading industry standards
Ensure patient-centered financial practices are embedded into the revenue cycle, including: Compliance with price transparency rules and accurate advance cost estimates, Patient-friendly billing statements, digital payment options, and financial counseling services, Integration of charity care and financial assistance programs into billing workflows, Monitoring and improving patient satisfaction with billing and collections
Other duties as assigned
Qualification
Required
Bachelor's degree in healthcare administration, business, or another related field
8+ years of progressive experience in healthcare revenue cycle operations, with at least 5 years in a supervisory or management role, demonstrating expertise in billing compliance, coding oversight, payer contracting, and denials management
Minimum of three years leading and managing staff
Competency in Electronic Health Record (EHR) and billing systems, with direct experience in Cerner revenue cycle applications and related payer workflows
Strong analytical skills, adept in interpreting strategic vision into measurable financial and operational outcomes and experienced in leading change
Proven ability to effectively communicate with all levels of staff personnel and leadership
Strong ethics and a high level of personal and professional integrity
BLS certification required within 6 months of employment
Preferred
Master's degree in business, healthcare administration, or a related field
One of the following certifications is preferred: RHIA (Registered Health Information Administrator), CRCR (Certified Revenue Cycle Representative), or CHFP (Certified Healthcare Financial Professional)
Experience leading optimization projects or implementations in Cerner or comparable revenue cycle platforms
Experience working with Critical Access Hospitals
Active membership in HFMA, AHIMA, or a similar professional organization
Company
Valor Health
Valor Health is a health care organization that provides both inpatient and ambulatory care for citizens.
51-200 employees
Funding
Current Stage
Growth StageTotal Funding
unknown2020-09-01Series Unknown
Leadership Team
Corey Furin
CFO
Company data provided by crunchbase