Job Description
Lead the analysis and optimization of end-to-end revenue cycle workflows and processes, including patient access, charge capture, billing, coding, collections, denials management, and payment posting. Analyzing to identify inefficiencies, bottlenecks, and areas for improvement. Utilizing Revenue Cycle expertise to enhance automation, data accuracy and reporting capabilities. Lead and manage process optimization projects from planning through execution and evaluation. Collaborate with cross-functional teams including billing, coding, patient access, IT, and compliance to identify operational inefficiencies and implement sustainable solutions. Serve as the subject matter expert (SME) for IDX system functionality, configuration, and optimization. Develop and maintain documentation for new processes, workflows, and system enhancements. Monitor and analyze key performance indicators (KPIs) to assess impact and ensure continuous improvement with the generation of reports to track the impact of optimization efforts. Driving adoption of best practice with industry trends, regulatory changes, and fostering a culture of innovation and accountability. Enhance transparency and accountability in the revenue processes. Supports organizational goals through data-driven decision making. Partners with RCM Learning & Development team to develop/deliver training programs and educational materials to revenue cycle staff to ensure adherence to new or optimized processes. Lead root cause analysis and performance audits to identify inefficiencies, reduce rework, and improve reimbursement timelines and payer compliance. Develop and implement strategies to improve RCM KPIs such as AR days, first-pass resolution rate, denial rate, and net collection rate. Responsible for the successful delivery of projects including the creation and maintenance of all required project documentation, budget adherence, and on-time delivery. Identify gaps in workflow, training, or systems and create sustainable process improvement plans using Lean, Six Sigma, or similar methodologies. Partners with Application and Support to create and present performance dashboards, executive reports, and business cases for optimization projects to senior leadership. Establish and track benchmarks to monitor the impact of implemented changes and ensure sustained process optimization. Ensure that all process improvements and operational changes comply with relevant regulations and industry standards. Stay current with industry trends, payer changes, and regulatory requirements to proactively adapt reimbursement strategies. Required Experience and Competencies. Bachelor’s degree in healthcare administration, Business, Finance, or related field required required. Minimum 5 years of experience in revenue cycle management, with at least 2 years focused on process improvement required. Proven experience working with IDX (GE Centricity Business) in a healthcare setting required. Established track record of success in optimizing complex processes required. Certified Associate in Project Management (CAPM), Project Management Professional (PMP), or Lean Six Sigma certification required. Experience with data visualization tools (e.g., Tableau, Power BI) preferred. Familiarity with other EHR/PM systems and healthcare IT platforms preferred. Change management experience in a healthcare environment preferred. Strong knowledge of healthcare billing, coding, reimbursement methodologies, and compliance regulations. Deep understanding of healthcare revenue cycle management. Advanced proficiency in IDX system. Proficiency in data analysis tools and revenue cycle software. Excellent analytical, leadership, problem-solving, and project management skills. Strong communication and interpersonal skills with the ability to influence stakeholders at all levels. Knowledge of organizational change management techniques and methodologies. Ability to dissect existing workflows, identify bottlenecks, and understand how different parts of a process interact. Ability to define problems, gather and validate data, perform root cause analysis, and help develop a solution. Ability to identify project issues, risk, weaknesses and/or critical problems, and to implement timely corrective action to forestall or remedy. Ability to plan, organize, and manage process improvement projects from start to finish. Ability to use project management software to define, plan, size, resource, manage, and report on assigned projects. Ability to track, monitor and evaluate budgetary compliance, and to manage project budget details and reporting. Ability to manage multiple projects from inception to successful implementation, and to demonstrate persistence in issues tracking, follow-up and resolution. Ability to explain project concepts/requirements to technical and non-technical audiences, and to convey information effectively in verbal and written communication, and group meetings/presentations. Proficiency in Microsoft Office suite (Outlook, Word, Excel, PowerPoint). Trainings to help support and advance your professional growth. Dental, Vision, HSA/FSA, Life and AD&D coverage, and more. Master’s degree preferred. EAP, travel assistance, and identify theft included.