Associate Vice President - Process Excellence (U.S Healthcare RCM)

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:

• Bachelor’s degree, or a related field (Master’s degree preferred).

Experience:

• Minimum of 12 years of experience in revenue cycle management, claims reimbursement, and healthcare operations, with at least 5 years in a leadership or senior management role.

• 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:

• Excellent communication and presentation skills, with the ability to explain complex data and technical concepts to both clients and non-technical stakeholders.

• 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.

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