Job Description
Does being on the inside of a transformational organization sound exciting to you? Well, read on! Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation’s premier health innovation company. Through our health services, insurance plans and community pharmacists, we’re pioneering a bold new approach to total health. As a CVS Health colleague, you’ll be at the center of it all!
Reporting to the Vice President - Revenue Cycle CVS Specialty and Coram, and a member of the Finance Operations Leadership Team, as the Senior Director – Coram Revenue Cycle for CVS Health, you will plan, develop and lead all functions that contribute to the recognition, management, billing and collection of patient service revenue from all payers. You’ll be responsible for the overall management of Specialty Pharmacy billing, revenue recognition, contracts/pricing and revenue cycle analytics. This role requires outstanding leadership abilities and the ability to collaborate with many operations enterprise-wide in order to improve quality, customer service and financial sustainability. Key duties include supervising revenue cycle initiatives, monitoring third party contracts and preventing payment denials.
This position is responsible for:
Development and administration of a Coram Revenue Cycle strategy, in conjunction with other CVS Revenue Cycle operations, to ensure the department is positioned for long-term success.
Daily management of Coram Revenue Cycle; approximately $2 billion in yearly revenue, key metrics and management of staff.
Results for key metrics of approximately $680M million in Gross Accounts Receivable. This includes Days Sales Outstanding, total A/R, oversight of bad debt and revenue adjustments, billing, credit balance management and related cash collections and postings.
Develop, implement and direct staff in achieving approved goals, objectives, and related program changes, in accordance with corporate guidelines.
Incorporating best management practices in the achievement of goals and objectives. This includes communicating and working with other management across the CVS Enterprise.
Management of a staff of approximately 350+ employees in two locations. This includes Directors, Managers, Supervisors and related staff.
Manage third party vendor relationships related to billing, collection, and cash posting activities.
Assure compliance for all regulations associated with Government directed programs within the A/R area.
Duties and Responsibilities:
Management of billing, collection, and cash application and all associated accounts receivable activity at all related locations.
Management of staff of approximately 350+ associates, including managers, supervisors, senior reimbursement reps, account associates, cash application associates, credit associates, accountants, systems analysts, payer contracting associates and bad debt specialists.
Identify and secure appropriate reports to manage accounts receivable.
Analyze AR, identify problem areas/trends, recommend and implement and produce solutions to problem areas enabling positive results.
Monitor compliance for all payors and governmental agencies.
Manage internal audits and review process to address problem areas to ensure compliance to internal processes and procedures and maximize performance.
Management of specific projects as directed by senior management.
Required Qualifications
• 15 years of positive management results in revenue cycle operations and employee development
• 10 years of experience in healthcare finance, third-party and receivables management
• Thorough knowledge of federal, state and local regulations as related to financial operations within healthcare
• The ability to evaluate, understand and use integrated financial software systems
• The ability to prioritize, assess and delegate responsibilities throughout revenue cycle operations
• 15 years’ experience in supervising management level personnel with strong motivational and team-building skills
• Previous experience with system development, audit, program implementation, operations integration and staff training
• Medical and pharmacy reimbursement experience required
• Extensive knowledge of healthcare insurance billing and collection functions for government and private payors
• Extensive knowledge of cash application process and associated functions
• Extensive knowledge of credit resolution process and Office of Inspector General responsibilities
Preferred Qualifications
• Outstanding attention to detail
• Excellent shown interpersonal skills with ability to lead, teach and motivate others
• Excellent analytical skills
• Ability to adapt to high-pressure and high-volume situations
• Exhibit good judgment in escalating issues to senior management staff as well as proposed solutions
• Excellent decision-making capabilities
• Excellent organizational and prioritization skills
• Excellent verbal and written skills
Education
A Bachelor’s degree in related field; Master’s Degree highly preferred
Business Overview
At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.