Key Responsibilities
Strategic Leadership & Vision: - Develop and execute the overall vision and strategy for the Revenue Recovery service line, ensuring alignment with corporate goals.
- Serve as the company's foremost subject matter expert on denial management and underpayment recovery, advising executive leadership on market trends, strategic opportunities, and emerging technologies.
- Drive a culture of accountability, continuous improvement, and high performance within the team, fostering individual motivation and professional development.
- Establish and own the service line's P&L, developing and managing operating budgets, forecasting revenue, and ensuring profitability.
Operational Oversight & Performance Management: - Provide executive leadership and oversight for the Clinical Nurse Manager and the Revenue Recovery Manager, ensuring their teams meet and exceed all operational and financial targets.
- Define, monitor, and report on Key Performance Indicators (KPIs), including denial rates, appeal success rates, recovery velocity, A/R days, and cost-to-collect.
- Lead the continuous optimization of workflows within the Health Innovas "Pulse" platform and our selected AI partner's tools to maximize efficiency and effectiveness.
- Analyze performance data to identify systemic root causes of revenue leakage and lead the development of enterprise-level prevention strategies.
Client & Stakeholder Collaboration: - Serve as the primary executive liaison for the Revenue Recovery service, building and maintaining strong, collaborative partnerships with Insource client leadership, including hospital CFOs and VPs of Finance.
- Prepare and deliver executive-level presentations and business reviews to clients, translating complex operational data into clear financial impact and strategic recommendations.
- Collaborate effectively with internal leaders, including the Business Enablement team, IT, and Sales, to ensure seamless service delivery and strategic alignment.
Technology & Innovation: - Lead the strategy for leveraging technology to create a competitive advantage, including the full optimization of the Pulse platform and the integration of agentive and generative AI tools.
- Develop and maintain a roadmap for automation to improve processes, reduce administrative burden, and lower the overall cost-to-collect.
Qualifications and Skills
Required: - Bachelor's Degree in Healthcare Administration, Business, Finance, or a related field. Master's Degree (MHA, MBA) is highly preferred.
- A minimum of 10 years of progressive experience in healthcare revenue cycle management, with deep expertise in back-end operations, including denial management, underpayment recovery, and AR management.
- At least 5 years of experience in a senior leadership role (Director level or above) with a proven track record of building and leading high-performing teams and managing a P&L.
- Strong financial acumen and exceptional analytical skills, with the ability to analyze complex data sets, identify trends, and make data-driven strategic decisions.
- Excellent communication, presentation, and interpersonal skills, with the ability to build trusted relationships and communicate effectively with C-suite executives, clinical leaders, and internal teams.
Preferred: - Experience in an outsourced RCM, vendor, or consulting environment.
- Demonstrated experience implementing and optimizing revenue cycle technologies, including workflow management platforms and AI/automation tools.
- Industry certifications such as HFMA-CRCR or FHFMA.
- Experience with LEAN, Six Sigma, or other process improvement methodologies.
