Payment Center Leader

Full job description

Overview:

Klarity Health is seeking a dynamic Payment Center Leader to spearhead the operations of our payment center. This pivotal role is designed to enhance Klarity Health's payment center by developing and implementing comprehensive payout optimization strategies. The Payment Center Leader will be instrumental in identifying opportunities for improvement, establishing proactive monitoring systems to mitigate issues early, and ensuring best practices are applied across all revenue collection activities. Collaborating closely with cross-functional teams, including Product, Provider and User Support, Compliance, and the Executive team, the Lead will drive initiatives to maximize billing and collections efficiency and operationalize new and existing payer contracts.

Responsibilities:

• Formulate and execute a comprehensive strategy to improve revenue collections and provider payout across the entire revenue cycle, ensuring alignment with technological resources and patient experience.
• Establish a robust foundation for supporting insurance billing, including the management of appeals, requests for information, and provider disputes.
• Design and implement strategies for efficient payment dispute management and identify additional revenue opportunities through service provision.
• Manage both in-house RCM teams and outsourced revenue cycle vendors, optimizing billing and collections processes.
• Build out the functional and personnel organizational charts to support the Payment Center
• Draft policies and process documents to introduce process rigor and standardization into Payment Center operations
• Resolve billing and collection issues promptly, acting as the company's subject matter expert on coding and billing queries.
• Spearhead cross-functional operational changes and initiatives, considering their impact on both internal and external stakeholders.
• Set and monitor internal KPIs for billing and RCM processes against industry benchmarks, overseeing billing department operations, including medical coding, claims submissions, and accounts receivable follow-up.
• Ensure compliance with Federal, State, and payer regulations, guidelines, and requirements, and participate in the development and implementation of operational policies and procedures.
• Conduct audits to enhance billing and collections operations efficiency and analyze trends to realign processes as needed.

Requirements:

• A minimum of 10 years' experience in revenue cycle operations, with virtual care or startup experience strongly preferred.
• Experience building and operating a cash pay provider billing system.
• Billing and/or coding experience or certification preferred.
• Demonstrated ability to work at startup pace, making strategic, data-driven decisions.
• Exceptional ability to think strategically about the entire revenue cycle and prioritize initiatives.
• Proven track record of innovative approaches to improve collection rates.
• Strong analytical skills with a keen attention to detail and industry best practices in RCM.
• Effective collaboration skills with technology and cross-functional teams.
• Proactive approach to identifying and addressing revenue leakage opportunities.
• Flexibility to adapt to a rapidly changing environment and prioritize based on organizational growth and needs.
• Leadership skills to motivate, coach, and effectively manage a team, ensuring optimal resource allocation.

Competencies:

• Strategic thinking with the ability to make decisions based on data and business judgment.
• Strong leadership and team management skills.
• Excellent problem-solving skills with a focus on efficiency and compliance.
• Adaptability in a fast-paced and evolving startup environment.

This role reports directly to the Head of Operations and offers a unique opportunity to significantly impact Klarity Health's operational efficiency.

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