Head of Revenue Cycle Management (RCM)

Virta Health is on a mission to transform diabetes care and reverse the type 2 diabetes epidemic. Current treatment approaches aren’t working—over half of US adults have either type 2 diabetes or prediabetes. Virta is changing this by helping people reverse type 2 diabetes through innovations in technology, personalized nutrition, and virtual care delivery reinvented from the ground up. We have raised over $350 million from top-tier investors, and partner with the largest health plans, employers, and government organizations to help their employees and members restore their health and live diabetes-free. Join us on our mission to reverse diabetes in 100M people by 2025.

Virta has an outcomes based pricing model and we are only paid when our patients achieve critical health outcomes (reduced HbA1c, weight loss, medication reduction). The Head of Revenue Cycle Management plays an integral role in keeping our business running and achieving our goal of being paid based on outcomes.

We are looking for someone who has a background in healthcare provider revenue cycle - specifically, understands the mechanics/complexity of medical claims billing and financial health KPI reporting. This individual will be willing to roll up their sleeves and own the day to day revenue cycle management responsibilities, enjoys working cross-functionally to automate and improve every detail of our revenue cycle and is able to report on the financial stability of our business to our leadership team. We are looking for someone who can wear multiple hats, is a self-starter and is passionate about improving the financial health of our business. Finance and accounting experience is a plus, but not required.

The Head of Revenue Cycle Management will sit on our Finance team and report into the VP of Accounting.

This is a REMOTE position. 

Responsibilities

• Partner with the Engineering, Product, and Operations teams to continue to introduce automation to our claims billing processes and to build & scale fee for service opportunities.
• Continuously work to identify areas of improvement and develop processes and documentation in the Company’s revenue cycle.
• Develop revenue cycle-specific policies in regards to: payer follow-up, appeals, write-offs, rejected claims, etc.
• Build out reporting for revenue cycle KPIs, including claim denial rates, claim write-offs, charge lag, time to cash, etc.
• Manage new client and partner enrollments in order to submit claims, monitor initial claim processing, automate submission and report to leadership on the reimbursement of specific accounts.
• Own the entire life-cycle of billing for a new client, including taking part in external calls with clients, payer integration, health plans, partners and representing Virta as the revenue cycle subject matter expert.
• Own end to end claims revenue cycle transformation projects including documentation and coding (optimizing codes we are currently billing, expertise in FFS billing and telehealth codes).
• Claims submission and management.
• Denials and A/R management.
• Collections and payment posting.
• Reporting and metrics.
• Project manage the entire Revenue Cycle function, setting up new payment structures as we expand our program offerings.
• Evaluate systems and tools to improve revenue cycle management efficiency.
• Communicate cross-functionally with the Sales and Customer Success teams on upcoming customer deals/launches & ensuring that customer requirements are being fulfilled and escalating any issues that arise with specific accounts.
• Act as the intermediary between the Commercial team and the Product and Engineering teams for any billing and reimbursement-specific requirements and troubleshooting issues.
• Train and educate team members on RCM best practices and industry benchmarks to improve revenue cycle metrics and build team accountability around following up on unpaid claims with carriers on a regular cadence.
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90 Day Plan

Within your first 90 days at Virta, we expect you will do the following:

• Identify and implement resolutions for existing issues impacting claims billing; defining Virta’s claim submission policies and procedures to avoid future issues
• Identify areas for process/systems optimization to drive cash KPIs 
• Build reporting and tracking for the end to end claims process from submission to payment receipt

Must-Haves

• At least 7+ years of experience in healthcare provider revenue cycle
• Previous leadership experience and management of a team
• Advanced Excel skills
• Persistence when working/communicating with payers
• Experience working cross-functionally with different teams
• Experience project managing internal projects
• Working knowledge of industry best practices in Revenue Cycle processes: billing, charge capture, contractual adjustments, third-party reimbursements, and collections and cash management
• Fundamental knowledge of revenue integrity (i.e. CPT and ICD-10 coding) and documentation requirements for billing and compliance
• Knowledge of payor policies, payor plans and processes related to coding and claims billing
• Expertise with fee for service billing/coding & telehealth coding/billing
• Comfortable working with the ambiguity of a fast-paced startup
• Efficient written and verbal communication skills
• Attention to detail, exceptional organizational and problem-solving skills
• Degree in accounting, finance or business preferred, but not required
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Values-driven culture

Virta’s company values drive our culture, so you’ll do well if:

• You put people first and take care of yourself, your peers, and our patients equally
• You have a strong sense of ownership and take initiative while empowering others to do the same
• You prioritize positive impact over busy work
• You have no ego and understand that everyone has something to bring to the table regardless of experience
• You appreciate transparency and promote trust and empowerment through open access of information
• You are evidence-based and prioritize data and science over seniority or dogma
• You take risks and rapidly iterate

As part of your duties at Virta, you may come in contact with sensitive patient information that is governed by HIPAA. Throughout your career at Virta, you will be expected to follow Virta's security and privacy procedures to ensure our patients' information remains strictly confidential. Security and privacy training will be provided.

For this role the compensation range for candidates in Colorado is $155,570 - $178,817; information about Virta’s benefits is on our careers page at: https://www.virtahealth.com/careers. 

Note: Starting pay will be based on a number of factors and commensurate with qualifications & experience. Virta has a location based compensation structure; there may be a different range for candidates in other locations.

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