VP, Revenue Cycle

PURPOSE AND SCOPE:
Supports US Vascular/Fresenius Vascular and FMCNA’s mission, vision, core values and customer service philosophy.  Adheres to the FMCNA Compliance Program, including following all regulatory and FMS/USV/FVC policy requirements.   Oversees all A/R functions for USV/FVC facilities to provide timely collections on A/R balances due the company and properly administers write-offs relating to bad debt in accordance with all applicable company, industry, and regulatory requirements.  Implements cost containment strategies as appropriate.  Responsible for assuring proper implementation of all state and federal regulatory requirements applicable to the specific provider type and assisting with evaluation of reimbursement and coding from Federal and Private Payers for vascular access services. Oversees compliance with FMCNA Compliance Policies, governmental processing and reporting requirements to ensure external reporting is timely and accurate.  Oversees and monitors payer contracting functions for all Access Site locations.  Oversees and monitors intake process including patient registration and insurance verification for all Access Site locations.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Reimbursement
  • Monitors the day to day functions of the Patient Intake, Billing, Cash Posting and Accounts Receivable departments
• Ensuring appropriate internal controls, timeliness, accuracy, and adherence to Corporate and governmental policy is maintained.
• Ensuring that patient accounts are correctly billed to the appropriate payer and that revenue is properly recognized.
• Monitoring daily deposits via cash posting department for accuracy.
• Overseeing the monthly close process of the Advantx and Medical Manager sub-systems and providing the accounting department with cash deposits, projected revenue, aging, bad debt, physicians’ compensation, patient mix and various standard reports.
  • Assuring reporting to Access Site locations of incorrect intake information and proper needed resolution.
  • Reviewing and monitoring routine follow-up activities of unpaid claims team for effectiveness;  setting performance measurements to improve collections performance;
  • Identifying, addressing and resolving USV related billing concerns.
  • Communicating with the relevant personnel and management regarding all major issues impacting billing operations and collections.
  • Participates in team meetings with Intake, Denial Management, Billing, Cash and Follow up teams to assure proper direction is obtained.
  • Assuring compliance with Medicare/Medicaid requirements and regulations by:
  • Maintaining current knowledge on Medicare, Federal, State and local regulations including reimbursement and procedure coding. 
  • Providing the appropriate personnel with CPT codes including ICD-9m correct coding initiatives and other valid updates. 
  • Reviewing interventional procedures to ensure maximum reimbursement is recognized and billed accordingly within Correct Code Initiatives guidelines as mandated by Medicare.
  • Assures the correct setup and utilization of billing software (Advantx/Medical Manager) and maintains system security and access ensuring compliance with FMS policies and regulatory requirements.
  • Monitors Accounts Receivable trends closely and addresses any collection issues including monitoring days outstanding to maximize cash flow and decrease Bad Debt Expenses.
  • Ensures correct fee schedules and pricing information are loaded into software application working with the appropriate personnel to resolve any system issues.
  • Addresses and resolves complex third party payer issues as escalated by billing staff.
  • Assures development and maintain training of Front Desk Coordinators as it relates to importance of correct information being collected, insurance verified, status if in nursing home and all related demographics.
  • Maintains historical and comparative data and identifies opportunities to improve operational performance.
  • Recommends methods for maximizing reimbursement and ensuring compliance with government and third party payers.
  • Establishes procedures for timely accumulation of accurate statistical data necessary for effective management of the revenue cycle.
  • Works closely with Finance/Accounting to insure that variances between GL and Patient Accounting reports/data are understood by all parties.
  • Assures appropriate internal controls are present to protect the Accounts Receivable asset.
  • Oversees each new site implementation prior to live and monitors the progress and any issues associated with the implementation; may become involved in resolving complex issues related to implementation.
• Financial Forecasting
• Reviews and establishes prospective revenue from new sites, determines expected reimbursement, anticipates required procedures.
• Monitors payer fee schedules for changes and updates.
• Maintains Medicare projection tool for accurate forecasting.
• New Site Implementation
• Meets with and reviews current set up if any.
• Establishes policy and procedures.
• Develops implementation time line.
• Develops staffing requirements needed to assure quality level expectation.
• Oversees payer contracting.
• Assures training is provides to include;
  • Front Desk Coordinator, expectations established and controls set.
  • Nurse Manager, assuring proper chart documentation is established.
  • Physician, review of policies regarding chart/charge sheet.
  • Monitors adherence to guidelines provided.
  • Leverages support from infrastructure team as required to support implementation.
  • Ensure each new site implementation has a project plan in place and monitors the progress and any issues associated with implementation, may become involved in resolving complex issues related to implementation.
  • Reviews all external audits provided by outside auditors/council.
  • Meets with internal FVC personnel to assure accurate start up
• Payer Contracting
  • Oversees payer contracting effort to assure timely resolution is achieved.
  • Suggests ideas/methods to achieve highest reimbursement achievable.
  • Assures potential contracts are favorable for the Physician group.
  • Oversees proper communication to the Physician group in a timely manner.
  • Manages internal activities of staff to assure timely responses from payers.
  • Assists in the negotiation of third party and direct contracts.
  • Meets / reviews with Physician groups to review contract content.
  • Oversees centralized data base that holds all information to assure contract detail is documented.
• Assist with various projects as assigned.
• Other duties as assigned

PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Day to day work includes desk and personal computer work and interaction with internal and external customers. Travel to regional, Business Unit and Corporate meetings may be required.

**Travel (up to 50%) will be required in order to conduct business at company sites (meetings, tours of operations) and participate in conferences.

 
SUPERVISION:

• FVC Director of Revenue Cycle
• FVC Manager of Revenue Cycle
• All Revenue Cycle staff

EDUCATION:
Bachelor’s Degree required; Business focus preferred

EXPERIENCE AND REQUIRED SKILLS:

• Minimum of ten years medical reimbursement experience with eight years supervisory experience.                
• Minimum of eight years medical regulatory and compliance experience.
• Proficient with MS Office products with advanced Excel skills.
• Knowledge and experience with automated revenue management system.
• Multi-location management experience is required.
• Self-starter with an ability to interact with management and staff personnel in field, BU and corporate
• Excellent communication skills both - written and verbal.

If your location allows for pay/benefit transparency, please click the link below to request further information on this position.   Pay Transparency Request Form

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.