3 essential skills hospitals need in RCM leadership

The role of hospital and health system revenue cycle management leader is evolving to encompass far more than billing and collections. These leaders are taking on more strategic roles that require a broader view of the revenue cycle.

The shifts in RCM leadership are reflected in different executive titles. More traditional director-level roles, such as director of RCM, are still common but, increasingly, these positions are moving to the vice president level — vice president of revenue cycle and chief revenue officer are common titles for top RCM executives. The vice president designation comes with the increasing scope of these roles, as RCM leaders now have a more tangible impact on the hospital or health system's financial and market success. As these roles are increasingly difficult to fill, organizations are positioning the role at the VP level to appeal to top candidates' ambition and desire to excel.

Becker's Hospital Review recently had the opportunity to catch up with David Boggs, head of WK Advisors, a division of executive search firm Witt/Kieffer. Mr. Boggs, who has recruited many vice presidents of RCM and similar roles in the healthcare financial arena, weighed in on the essential skills a hospital or health system needs in RCM leadership to be successful in today's healthcare market.

Three essential skills

1. Broad view of the revenue cycle. Revenue cycle leaders must not only be subject matter experts in billing and collections, but also many other connected areas. This includes innovation within the patient registration process, improving the ease and accuracy of patient coding in alignment with increasingly sophisticated regulatory standards such as ICD-10, integration with insurance/managed care contracting, and innovation with regard to working proactively with patients who have high deductible health plans. Understanding and utilizing information technology for innovation in all of these areas are absolute keys for success, according to Mr. Boggs.

"Having a strategic understanding and a broader understanding of the areas outside of billing and collections is important," Mr. Boggs says. "Getting the bill out and collecting it are critical, but so are having the analytics in place to ensure you are collecting what you're supposed to collect, making sure contracts are paid at the level they're supposed to be paid, and ensuring that coding is accurate so it won't be denied later. It's a big-picture role."

2. Strategic understanding of the utilization of technology. Mr. Boggs says today's RCM executives must have a keen sense of how the organization admits and codes patients and how this process can be streamlined and optimized through the strategic application of integrated EHR systems. "The revenue cycle executive has to make sure coding is accurate," he says. "And as we get into the world of high deductibles, this role must ensure there are tools to predict what the patient's balance is going to be before they leave the hospital, and for the organization to have a proactive plan in place to anticipate issues with coverage and reimbursement."

3. Ability to communicate and work with other key leaders and staff. Revenue cycle executives typically oversee and/or collaborate with leaders in areas such as patient registration, health information management, physician business services and case/utilization management, Mr. Boggs notes. Revenue cycle leaders don't have direct authority in some of these areas, but it is vital they are still able to exert influence. This includes working directly with physicians, nurses and registration staff across multiple locations to ensure they understand revenue cycle processes that are in place, are using the organization's software and IT systems appropriately, are determining the appropriateness of admissions and denials, and are providing input about how billing, collecting and related activities can be improved. There must be communication within individual facilities as well as across systems about revenue cycle issues, Mr. Boggs says.

Furthermore, today's revenue cycle executives must be skilled trainers and mentors. "There is usually a significant element of employee education and training that needs attention as well, since standard practices and regulations in regards to revenue are evolving," Mr. Boggs says.

Recruiting revenue cycle leadership

The essential skills a hospital or health system needs in RCM leadership, like the three noted above, require a mix of technical and people skills. In terms of technical skills, revenue cycle leaders typically must have a four-year degree in accounting, finance or business administration, with an advanced degree or Healthcare Financial Management Association certification preferred, according to Mr. Boggs. These credentials help ensure revenue cycle executives have strong financial analysis skills, understand financial management, cash flow and have the ability to analyze and act upon situations quickly.

Knowledge of governmental and managed care reimbursement is also important, he says. Typical experience would be about a decade of revenue cycle work, with at least five years at the management level for a multi-facility system.

In terms of interpersonal skills, revenue cycle leaders learn through doing, but also are increasingly expected to exhibit communications and leadership skills. Mr. Boggs says healthcare organizations are prioritizing interpersonal and "soft" skills among those they recruit, while also looking to see if candidates have management training and certification, communications experience, are open to coaching and leadership development activities, and in general embrace the more strategic and non-technical aspects of their work.

Where are hospitals and health systems finding revenue cycle leaders with a mix of the right personal and technical skills? In Mr. Boggs' experience, strong revenue cycle leaders historically have come out of a healthcare organization's patient financial services or billing areas. However, he is starting to see them emerge out of other areas such as health information management, coding, decision support and financial operations. Mr. Boggs says leaders in those areas tend to have had broader responsibilities, more established relationships throughout different functional areas and across facilities, and a higher-level view of the organization.

He says revenue cycle leaders also on occasion might come out of a consulting background where they were designing revenue cycle systems and have worked on implementations and optimizations at different healthcare organizations. Because of the industry-specific nature of the work, it isn't likely RCM leaders can be recruited outside of healthcare. What this means, says Mr. Boggs, is recruiting will be very competitive for the select few individuals who have proven experience in both the technical and strategic aspects of these roles.


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