Title: Vice President, Billing and Credentialing Services
Reports to: Chief Financial Officer
Organization Summary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 with 9 health centers and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices across Massachusetts. We are an innovative organization developing new partnerships and programs to improve the health of members and communities and to strengthen our health center partners.
Job Summary:
The Vice President (VP) of Billing and Credentialing Services builds and oversees the revenue cycle services and all aspects of a new billing and credentialing service of Community Care Cooperative (C3). The VP is responsible for overall revenue cycle operations including the management of total outpatient medical, behavioral health, eye, and dental claims receivables on behalf of a core client group of Federally Qualified Health Centers (FQHCs). This role will also oversee upstream drivers of revenue integrity such as eligibility verification, cash management, provider credentialing, and reporting and technology for RCM. The VP ensures that all billing, compliance, and payer regulations
are followed to drive the collection of $40 million in net revenue for one FQHC client initially. The VP will maintain excellent relationships with current and pipeline FQHCs, will clearly demonstrate value and quality, and will sustainably grow the service to multiple FQHCs over time. Additionally, they must have deep FQHC revenue cycle management experience. Preference will be given to candidates with Massachusetts payer expertise, especially with the MassHealth and Health Safety Net Programs.
Responsibilities:
- Build from the ground-up and direct a new billing and credentialing service of C3 to improve revenue capture for client FQHCs
- Functions to be built and overseen by the VP include but are not limited to:
o Payer and patient accounts payable (medical billing)
o Payer and patient accounts receivable management
- Cash management
- Collections
o Eligibility and benefits verification
o Provider credentialing
o Accurate processing of capitated and value-based payer contracts
- Write and maintain Service Level Agreements (SLAs) and render contracted deliverables with excellent quality and high degree of financial value to clients
- Develop and oversee total staffing strategy, including hiring staff and vendors, putting in place a management structure and career development ladders, and ensuring robust staff certification, onboarding, and training processes
- Develop and oversee the billing and credentialing service budget, managing expenses and planning for staffing to meet FQHC needs
- Build the infrastructure to monitor, coordinate, and evaluate the performance of RCM operational areas. Proactively initiate process & system improvements for the ongoing enhancement of service performance
- Develop and apply Compliance policies and standard operating procedures to ensure applicable laws, regulator considerations, policies, and procedures which govern proper medical conduct, medical billing, and healthcare are followed by team members and contracted entities, if any. Handle escalations as needed or when/if violations in compliance are identified. This includes building and operating an internal audit function
- Prepares year end revenue related accounting and audit work papers. Responds to audit questions as appropriate
- Assess existing and coordinate with key stakeholders to optimize billing technology and equipment, inclusive FQHCs EHRs and Community Technology Cooperative (CTC), an instance of EPIC managed by C3
- Develop collaborative relationships with internal stakeholders, including but not limited to Finance, Compliance, CTC, and the C3 Risk Coding team
- Serve as the externally facing Executive accountable for resolving issues as needed and maintaining excellent relationships with both existing and pipeline FQHC customers
- Sustainably grow the RCM offering to multiple FQHCs over time
- Perform other duties as assigned in support of C3 and the billing and credentialing service
Required Skills:
- Proven record of successfully leading a complete revenue cycle management function that delivered financial value within a complex outpatient healthcare environment
- Proven record of working with and understanding outpatient medical, behavioral health, dental, and eye payer billing and compliance rules within the State of Massachusetts
- Demonstrated ability to establish a business or function from scratch whilst being flexible and open to change in a fast-paced growth environment
- Demonstrated ability to develop, monitor, and use data to ensure value and continuous process improvement
- High standards of quality and attention to detail
- Executive level communication skills, conveying a high degree of poise, accountability, and expertise
Desired Other Skills:
- Experience working in Epic revenue cycle
- Familiarity with the MassHealth ACO program
- Familiarity with federally qualified health centers
- Experience with anti-racism activities, and/or lived experience with racism is highly preferred
Qualifications
- Master’s or higher degree in a relevant discipline
- 8+ years of progressive leadership experience effectively managing and successfully improving revenue cycle operations in a large, complex, multi-facility outpatient healthcare environment
- 3+ years’ experience in an advanced leadership role within a Federally Qualified Health Center
- 3+ years’ experience with outpatient medical billing rules for Massachusetts payers, especially MassHealth and the Health Safety Net programs
C3 is an Equal Opportunity Employer
In order to provide equal employment and advancement opportunities to all individuals, employment decisions are based on merit, qualifications, and job-related abilities. The Company is committed to a policy of non-discrimination and equal opportunity for all applicants and employees in recruitment, hiring, placement, promotion, compensation, discipline, demotion, transfers, layoffs, return from layoffs, terminations, access to training, and agency-sponsored programs and activities without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, ability, veteran status, military service, genetic information, receipt of free medical care, or any other category protected under applicable federal, state or local law.