Process Improvement Director, Revenue Cycle & Back Office Operations (Must reside in Las Vegas area)

COMPANY OVERVIEW

NovumHealth, backed by Chicago Pacific Founders, establishes high performance networks with healthcare providers to enhance access to care for Medicaid, Medicare, and Commercial members.

Our efforts result in significant improvements, including same-day access to urgent and routine care and timely appointments for accurate diagnoses and effective treatments.

We are dedicated to high-quality care, accessible appointments, and mental health equity.

NovumHealth’s model achieves remarkable outcomes, such as a 70% reduction in rehospitalization rates and notable enhancements in key health outcome measures.

We specialize in addressing social determinants of health in the evolving healthcare landscape. By partnering with experienced providers offering evidence-based services, NovumHealth creates a comprehensive, community-based system of care that respects member choice and meets their unique healthcare needs.

POSITION OVERVIEW

As an accomplished professional with a diverse skillset, this incoming operator will seamlessly integrate process engineering expertise and a steadfast commitment to operational excellence.

In this pivotal role, they are poised to catalyze transformative change, elevating the organization to new heights of efficiency and performance.

He / She will be the driving force behind developing and implementing best practices, policies, and procedures across crucial areas such as call center management, claims processing, billing, and credentialing.

Through their strategic guidance, the organization will eliminate interdepartmental obstacles, optimize support for network clinics, and propel the entire enterprise towards unprecedented levels of efficiency and effectiveness.

With a keen eye for continuous improvement and a deep understanding of operational nuances, this role will play a pivotal part in elevating the organization's infrastructure to top-tier standards.

SCOPE OF RESPONSIBILITIES

• Analyze provider network processes and workflows to identify bottlenecks, redundancies, and areas for optimization in delivering accessible, quality care
• Promote a culture of continuous learning and innovation, identifying opportunities for refinement and enhancement in operational processes and systems to drive ongoing performance improvements and maintain top-tier standards.
• Spearhead projects aimed at enhancing operational efficiency and effectiveness across various functions, including call center management, claims processing, billing, and credentialing.
• Design and implement streamlined processes and procedures for building and managing high-performing provider networks
• Oversee revenue cycle management processes, ensuring timely and accurate billing, coding, and claims processing to maximize financial performance and minimize revenue leakage.
• Ensure compliance with industry regulations, payer rules, and organizational standards related to behavioral health care delivery
• Establish standardized policies, procedures, and protocols to streamline operations and promote consistency in service delivery, leveraging industry-leading methodologies and benchmarks.
• Champion operational excellence by enhancing overall provider network operations and care delivery processes
• Establish metrics and KPIs to track network performance, care access, quality outcomes, and cost efficiency
• Collaborate with internal teams and external partners to enhance care coordination efforts, facilitating seamless transitions between healthcare providers and improving patient outcomes.
• Foster an organizational culture of provider accountability and commitment to NovumHealth's mission
• Oversee provider services operations, including call center staffing and performance optimization
• Implement strategies to enhance provider experience and responsiveness to member needs
• Evaluate, refine, and execute processes for provider credentialing, contracting, claims submission, and reimbursement
• Streamline billing procedures and ensure timely, accurate provider reimbursements aligned with value-based models
• Serve as a cultural ambassador to bridge operational silos by fostering cross-departmental communication and collaboration

CANDIDATE QUALIFICATIONS

The ideal candidate would possess the following attributes :

• Bachelor's degree required, Master's degree or MBA preferred (field open)
• Progressive experience in process engineering or operations management roles within the ideally in healthcare
• Strong analytical, data analytics and process improvement skills (e.g. Lean, Six Sigma, etc.)
• Excellent project management abilities to lead cross-functional teams, manage priorities, and execute optimization strategies
• In-depth understanding of healthcare regulations, compliance, best practices, and their application to operational policies and procedures
• Exceptional communication, leadership, and coaching skills to foster a culture of accountability
12 days ago