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Position Summary

The Director, Revenue Cycle is responsible for strategic oversite of Specialty Revenue Cycle Process Improvement, Payer Relations, Reimbursement Analysis and Training and QA Departments. In this role, the Director is expected to aid the Revenue Cycle Department in reaching overall department goals through the proactive management of the IT budget, successful deployment of prioritized projects and end user support, accurate and timely creation and maintenance of all bill groups, payers, pricing, and associated edits, reimbursement analysis and training and quality audits.

The Director Revenue Cycle is also responsible for providing leadership and guidance to the department to ensure overall goals and priorities of the company and department are successfully achieved. This position will set department goals, provide stretch assignments and develop colleagues within the department.

Process Improvement

The Director will partner with the Process Improvement Leader and Revenue Cycle Leaders to develop and maintain the Revenue Cycle Capital Budget for IT projects ensuring secured funds are prioritized based on department need and resource availability. All assigned projects will be managed from inception through implementation, with a focus on ensuring delivered product meets the expected timelines and achieves the associated objectives. In addition, the Director will ensure end user support is provided across Specialty Revenue Cycle and system issues are communicated, escalated and resolved.

Payer Relations

The Director will partner with the Payer Relations Leader to provide strategic oversight for the department to ensure timely and accurate creation and maintenance of all insurance plans, pricing fee schedules, edits and system rules controlled through this department. In addition, the Director will ensure proper resource allocation for strategic initiatives requiring maintenance, analysis and support from the Payer Relations team. The Director will ensure there are thorough controls in place to monitor quality and timeliness for all entry performed directly by the department or coordinated through IT.

Reimbursement Analysis

The Director will partner with the Reimbursement Analysis Leader to provide strategic oversight to the department to complete timely and accurate reimbursement analysis, identifying and building action plans based on issues and trends identified. In addition, prepare and present routine reports on pricing performance, financial impact, and opportunities to senior management and key stakeholders, providing insights and recommendations for strategic decision-making.

Training and QA

The Director will partner with the Training and QA to ensure the Training and QA teams are partnering with RCM leaders to identify, design, develop, and implement training solutions that meet the learning and performance needs of RCM colleagues.

Required Qualifications

10+ years of related experience

5+ years healthcare technology experience, preferable in specialty pharmacy

8+ years progressive leadership experience in healthcare revenue cycle environment with notable increases in responsibility

Preferred Qualifications

-Proven ability to collaborate across business lines to work towards enterprise goals and objectives.

-Adept at building consensus with stakeholders with regards to strategy, direction, execution and delivery.

-Strong leadership skills, strategic mindset and experience leading highly functioning teams focused on identifying and implementing complex solutions.

-Ability to participate in development of resource plans and structures and influence organization priorities.

-Experience with diverse operating systems, including proven technical skills required to support the systems.

-Understanding of software development methodologies/lifecycle (SDLC) & proven ability to lead complex system projects from requirements through testing and implementation.

-Ability to interpret and communicate technical information into business language.

-Strong analytical skills with the ability to interpret financial data, identify trends, and develop actionable insights and strategies.

-Ability to meet deadlines across multiple workstreams with competing priorities and deliver results that meet or exceed expectations.

-Excellent verbal, interpersonal and written communication skills.

Ability to evaluate work and process flow to ensure optimal efficiencies.

-Experience working with revenue cycle applications and healthcare finance and accounting principles.

Education

High School Diploma/GED required

Bachelor’s Degree or higher preferred, relevant experience may be considered in lieu of degree

Pay Range

The typical pay range for this role is:

$100,000.00 - $231,500.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. This position also includes an award target in the company’s equity award program. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 08/23/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.