Associate Vice President - Process Excellence - Healthcare

Job Roles & Responsibilities:

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:

Experience:

- 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:

- 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.