Executive Director, Enterprise Billing Strategy, Bureau of Office of Chief at City of New York

New York, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

09 Oct, 26

Salary

200000.0

Posted On

11 Jul, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Medicaid Billing Infrastructure, Revenue Cycle Management, Claims Submission, Managed Care Contract Negotiation, EHR Configuration, Denials Management, Financial Reporting, Operational Leadership, Healthcare Access Strategy, Budget Management

Industry

Government Administration

Description

Job Description The Office of the Chief Medical Officer (CMO) launched in 2021 to facilitate collaboration and coordination among healthcare delivery partners and the Health Department around a shared vision for improving health in New York City. The CMO Office mission is to develop and implement anti-racist policies and programs in three key areas: Provider Communications and Engagement; Cross-Agency Clinical Coordination and Management; and Workforce Sustainability. Within this mission, revenue generation is not a back-office finance function but the mechanism that makes New York City's community health workforce financially durable: by converting community-based services into reimbursable care, the Department can sustain community health workers, doulas, peer specialists Office of the Chief Medical Officer is seeking to hire an Executive Director of Enterprise Biling Strategy and Healthcare Access. DUTIES WILL INCLUDE BUT NOT BE LIMITED TO: - Build Medicaid Biling Infrastructure from Design to First Revenue. The Executive Director must bring a demonstrated, hands-on track record of personally standing up billing infrastructure for non-traditional provider types community health workers, doulas, peer specialists, and health educators in a Medicaid-dominant payer environment, from initial design through first revenue generation, with measurable financial results. This is the central requirement of the role. The successful candidate has built such an operation before and can speak in specifics about how they did it and what it produced. - Manage the Ful Revenue Cycle. The Executive Director has the ability to lead a team of experts across divisions to oversee the complete revenue cycle lifecycle: charge capture, coding, claims submission, clearinghouse and EHR/billing-system configuration, denials and accounts receivable management, and revenue reporting. The role requires demonstrable fluency with electronic health record and claims systems, clearinghouses, and denials-management workflows, and the ability to partner credibly and at a technical level with the Department's technology staff and vendors. - Architect the Documentation-to-Claims Pipeline. The Executive Director leads a team of experts across divisions and builds the data flow that turns point-of-service documentation into clean, billable claims configuring community health worker documentation platforms and EHR builds so that the encounter, the eligibility data, the coding, and the claim move through one coherent pipeline. - Negotiate and Manage Medicaid Managed Care Contracts to Closure. The Executive Director has hands-on experience negotiating with Medicaid managed care organizations and a record of closing payer agreements that produced consistent reimbursement revenue. The role requires positioning a public health entity as a credible Medicaid billing provider and building and managing a sustainable portfolio of MCO contracts across New York City's Medicaid managed care landscape. - Own the Revenue Target, Manage Vendors and Partner with Finance to Enhance the Revenue-Cycle Team. The Executive Director owns a revenue target for non-traditional provider types and is accountable for its financial performance. The role includes managing the vendors that support documentation, claims and billing for non-traditional provider types and partnering with Bureau of - Revenue to enhance the revenue cycle unit to accommodate non-traditional provider-type billing. - Operational Leadership and Near-Term Delivery. The Executive Director is an exceptionally organized operator who drives concurrent workstreams to completion on hard deadlines. Near-term deliverables include achieving first Medicaid revenue by early 2027, executing managed care contracts with a target set of plans within the first year, and standing up claims operations at a defined volume. Why you should work for us: - Loan Forgiveness: As a prospective employee of the City of New York, you may be eligible for federal/state loan forgiveness and repayment assistance programs that lessen your payments or even fully forgive your full balance. For more information, please visit the U.S. Department of Education’s website (https://studentaid.gov/pslf/) - Benefits: City employees are entitled to unmatched benefits such as: o a premium-free health insurance plan that saves employees over $10K annually, per a 2024 assessment. o additional health, fitness, and financial benefits may be available based on the position’s associated union/benefit fund. o a public sector defined benefit pension plan with steady monthly payments in retirement. o a tax-deferred savings program and o a robust Worksite Wellness Program that offers resources and opportunities to keep you healthy while serving New Yorkers. - Work From Home Policy: Depending on your position, you may be able to work up to two days during the week from home. - Job Security - you could enjoy more job security compared to private sector employment and be able to contribute to making NYC a healthy place to live and work. Established in 1805, the New York City Department of Health and Mental Hygiene (NYC Health Department) is the oldest and largest health department in the U.S., dedicated to protecting and improving the health of NYC. Our mission is to safeguard the health of every resident and cultivate a city where everyone, regardless of age, background, or location, can achieve their optimal health. We provide a wide array of programs and services focused on food and nutrition, anti-tobacco support, chronic disease prevention, HIV/AIDS treatment, family and child health, environmental health, mental health, and social justice initiatives. As the primary population health strategist and policy authority for NYC, with a rich history of public health initiatives and scientific advancements, from addressing the 1822 yellow fever outbreak to the COVID-19 pandemic, we serve as a global leader in public health innovation and expertise. Come join us and help to continue our efforts in making a difference in the lives of all New Yorkers! Commitment to Equity: The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy. The NYC Health Department is an inclusive equal opportunity employer committed to providing access and reasonable accommodation to all individuals. To request reasonable accommodation to participate in the job application or interview process, contact Sye-Eun Ahn, Director of the Office of Equal Employment Opportunity, at [email protected] or 347-396-6549. HEALTH SERVICES MANAGER - 10069 Qualifications 1. A master’s degree from an accredited college in hospital administration, public health, community health, health administration, emergency preparedness planning/management, emergency medical services, fire safety, law enforcement, homeland security, project management, public administration, business administration, management, or administration and three years of full-time satisfactory experience in a health services setting such as a laboratory, hospital, or other patient care facility, or in a public health, community health, environmental health, school health, social services, or mental hygiene program, of which at least 18 months of experience must have been in a managerial or administrative capacity requiring independent decision-making concerning program management, planning, evaluation for quality improvement and assurance, allocation of resources, and the scheduling and assignment of work; or 2. A baccalaureate degree from an accredited college and five years of full-time satisfactory experience as described in “1” above; or 3. An associate’s degree from an accredited college and seven years of full-time satisfactory experience as described in “1” above; or 4. A four-year high school diploma or its educational equivalent plus nine years of full-time satisfactory experience as described in “1” above; or 5. Education and/or experience equivalent to "1" above. Education may be substituted for experience on the basis that each 30 graduate semester credits from an accredited college in hospital administration, public health, community health, health administration, emergency preparedness planning/management, emergency medical services, fire safety, law enforcement, homeland security, project management, public administration, business administration, management, or administration, or a related specialized area can be substituted for one year of non-managerial experience up to a maximum of 60 semester credits for two years. Furthermore, undergraduate education may be substituted for experience on the basis that each 30 semester undergraduate credits from an accredited college may be substituted for one year of non-managerial experience, up to a maximum of four years. However, all candidates must have a high school diploma or its educational equivalent and 18 months of managerial experience as described in "1" above. Additional Information The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy. Agency: DEPT OF HEALTH/MENTAL HYGIENE Job Category: Administration & Human Resources Salary Band: $150,000+ Compensation: USD 94050 - USD 200000

Responsibilities

The Executive Director will build and manage the Medicaid billing infrastructure for non-traditional provider types to ensure financial sustainability. This includes overseeing the full revenue cycle, negotiating managed care contracts, and architecting the documentation-to-claims pipeline.