Exact Billing Solutions ยท 1 day ago
Vice President of Utilization Review
Lauderdale Lakes, FL
Full-time
Onsite
Director/Executive
$200K/yr - $230K/yr
10+ years expExact Billing Solutions is a revenue cycle management company specializing in healthcare services for substance use disorder, mental health, and autism care. The Vice President of Utilization Review will oversee the strategic direction and operational efficiency of revenue cycle management functions, focusing on Out of Network and In-Network services, while driving business transformation and ensuring the seamless delivery of services.
BillingConsultingHealth CareMedicalSoftware
Responsibilities
Collaborates with various departments, including medical staff, finance, case management, and quality assurance, to achieve optimal patient outcomes and financial performance
Provide supervision and guidance to UR team, ensuring adherence to processes and protocols
Serve as point of escalation point for complex UR cases and assist the team in developing strategies for challenging negotiations
Conduct on-going audits of UR team members and report findings back to leadership
Collaborate closely with the UR Director to implement process improvements and support the team's alignment with organizational goals
Coordinate with clinical teams to support the department in gathering necessary documentation and developing individualized treatment plans for insurance submissions
Monitor team performance, provide regular feedback, and facilitate professional development opportunities
Build and scale high-performing teams that drive efficiency, accountability, and results
Develop and refine client onboarding, integration, and management processes to support a growing external client base
Shape the go-to-market strategy, working closely with business development and operational leaders to ensure seamless execution
Leverage AI and automation to create a best-in-class RCM platform that differentiates us in the market
Serve as the face of the company both internally and externally, representing our commitment to excellence and driving the vision forward. Lead with confidence, strategic foresight, and the ability to inspire teams to execute with precision
Externally engage with clients, partners, and industry stakeholders to ensure our value proposition resonates and meets the expectations of a growing client base. Nurture relationships, secure buy-in, and demonstrate the unique advantages of our RCM offering while fostering a collaborative and partnership-driven environment
Inspire a culture of accountability, high performance, and continuous improvement. Ensure operational health while creating an environment where teams feel empowered to excel, collaborate, and innovate
Qualification
Required
Bachelor's degree in Business Administration, Healthcare Management, or a related field
An MBA or other advanced degree is highly preferred
Minimum of 10 years of experience in operations management, with at least 5 years in a senior leadership role within the healthcare or RCM industry
Minimum 5-7 years of experience in utilization review or a related healthcare management role
Experience providing leadership and direction to a team to maintain and enhance customer relationships to meet the company objectives
Proven track record of successfully scaling operations and leading large, cross-functional teams
Experience with automation and AI integration in operational processes is a significant advantage
Strong strategic thinking and problem-solving skills, with the ability to translate vision into actionable plans
Excellent leadership and team-building skills, with a focus on fostering a culture of accountability and high performance
Exceptional communication and interpersonal skills, capable of engaging effectively with clients, partners, and internal teams
Proficiency in data analysis and performance metrics, with a keen eye for identifying trends and opportunities for improvement
Ability to manage multiple priorities in a fast-paced, dynamic environment
Familiarity with RCM software and tools, as well as general IT systems used in healthcare operations
Understanding of AI and automation technologies and their application in RCM processes
Deep understanding of the healthcare industry, specifically out-of-network RCM, including regulatory requirements and payer landscapes
Knowledge of market trends and best practices in RCM and healthcare operations
High level of integrity and ethical standards
Strong executive presence and the ability to inspire confidence and trust
Adaptability and resilience in the face of challenges and change
Benefits
21 paid days off (15 PTO days, increasing with tenure, plus 6 holidays)
Flexible Spending Account (FSA) and Health Savings Account (HSA) options
Medical, dental, vision, long-term disability, and life insurance
Generous 401(k) with up to 6% employer match
Company
Exact Billing Solutions
Exact Billing Solutions offers revenue cycle management to help reduce medical billing costs.
201-500 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase