Vice President, Revenue Cycle & Contracting

About us:

Forge Health is a mission-driven outpatient mental health and substance use provider dedicated to providing the highest quality, affordable, and effective “one-stop-shop” care to individuals, families, and communities in need. As the first and only behavioral healthcare provider with a proven, national payer-validated ability to drive clinical outcomes that span all areas of health, Forge Health is leading the charge in driving innovation, improving care delivery, and shaping the future of behavioral health care.

At Forge, clinical care is paramount – it’s the heartbeat of our operations and the driving force in everything we do. The skill and compassion of our staff are the crucial components to extraordinary experiences and outcomes for those we serve. With our current clinical footprint in the greater Northeast, we have offices in New York, New Jersey, Pennsylvania, New Hampshire, Massachusetts – and we’re growing! For the third consecutive year, were thrilled to share that Forge Health has been recognized on the prestigious Inc. 5000 list of the fastest-growing private companies in America– a remarkable honor that is a testament to our team's relentless commitment to our mission.

If you are passionate about providing high quality, evidence-based care for individuals in need through an innovative practice, then Forge is the right fit for you!

What We’re Looking For

Reporting to the CEO, the VP of Revenue Cycle & Contracting, will lead and oversee all aspects of Forge Health’s revenue cycle management (RCM) and payer contracting functions and initiatives. This role will be responsible for driving achievement of RCM performance, through continuous optimization of all revenue cycle operations and improvement of key processes. This role will also own the strategic development and oversight of payer contracting – both fee-for-service and value-based care arrangements – and will be responsible for creating and fostering key contacts with payer partners. This role will directly manage the Director of Revenue Cycle and will be responsible for evolving Forge’s RCM functions by ensuring proper operational systems and controls, administrative and reporting procedures, and department structure are in place to effectively drive revenue cycle scalability, revenue optimization, and payer relations.

As a highly experienced, collaborative, and hands-on key member of team, you will serve as a strong, trusted business partner and revenue cycle expert to the CEO and executive team by providing thought leadership and transparent input, support the overall leadership team in achieving strategic and financial goals, and prepare the RCM functions for scalability.

Please note, the successful candidate will ideally reside in any of our core markets (NY, NJ, PA), working primarily remotely, with the occasional need to be in-person.

What You’ll Do

Revenue Cycle Management

• Oversee all aspects of revenue cycle functions and initiatives and provide strategic thought leadership to Forge Health on mental health and substance use disorder services with commercial health plans, state Medicaid and managed-care organizations, and Medicare.
• Directly manage the Revenue Cycle operations team, including the director and their direct reports. Ensure operational execution on timely, high quality billing submissions.
• Drive continuous optimization of all revenue cycle operations by measuring, analyzing, and interpreting revenue cycle and reimbursement data to uncover trends and insights in revenue processes, payer-specific reimbursement, and other critical aspects of reimbursement.
• Establish measures of performance metrics and create dashboards that incorporate both internal and external payment data to identify key improvement areas to drive efficiencies and to ensure strong alignment and accountability on the team.
• Extract and compile data from various system sources to develop analyses leading to potential revenue cycle opportunities, conducting analyses related to billing system setup, charge capture, billing, and/or patient financial services.
• Develop, implement – and revise as necessary – revenue cycle management policies and procedures, process improvements, tools, and other resources (e.g. .e standardized playbooks, communication templates, training materials, resource guides, automation features, advanced tooling, etc.) that will maximize efficiency and optimize performance.
• Provide senior leadership oversight of the revenue cycle operation, driving performance/ operational planning, developing and monitoring performance objectives for the director and their direct reports.
• Oversee all aspects of existing and new payer contracts, including developing and managing an internal payer checklist to track, monitor, and proactively address credentialing, billing, and information integrity matters.
• Serve as subject matter expert and go-to person for all revenue, payer contracting, and reimbursement-related matters – including payer-specific requirements, reimbursement logic, accreditation requirements, and emerging trends and methodologies in managed care contracting – both internally and externally.
• Apply current knowledge and understanding of regulations, industry trends, current best practices, new developments, and applicable laws to ensure operational and financial effectiveness for revenue cycle functions. Partner to ensure regulatory compliance for all areas of responsibility.
• Proactively identify situations which require intervention (i.e. denials, underpayments, and other issues). Plan, prepare, and conduct corrective course of action(s) in partnership with key stakeholders.
• Identify and ensure revenue cycle management training needs at all levels of the organization, and foster change to achieve performance improvement initiatives.
• Monitor relevant policy at payers, states, and at the national level, and assess opportunities and threats related to emerging and evolving issues.
• Prepare impactful reports, analytics, summaries, and visualizations to communicate findings.

Contracting

• Develop, recommend, and implement payer contracting strategy for fee-for-service and value-based initiatives with commercial health plans, Medicaid, and Medicare partners – assist in leading and driving negotiations with existing and new payer partners.
• Create, develop, and maintain contacts with existing and potential contracting partners of new and existing payers.
• Rapidly approach payers to obtain new or improved contracts, quickly submitting new applications, following up on status, and escalating as needed to overcome barriers.
• Execute administrative duties as required, including maintaining lists of provider relations contacts, preparing reports on in-network payer status, and organizing contracted fee schedules, plans/products/networks, and contract agreements.
• Serve as the subject matter expert related to payer-specific requirements, reimbursement logic, accreditation requirements and other critical aspects of payer contracts. Ensures contracting efforts remain aligned with Forge Health strategic plan/goals.
• Provide input to senior management and key stakeholders relative to business development and strategic positioning as it relates to payer strategy including emerging trends and methodologies in managed care contracting, payer relations and new payment models that support the strategic goals of Forge Health.
• Assess performance to identify need for amendments of existing contracts.
• For new relationships or service lines, performs business and market analysis to determine viability of right type of contracting.

What You’ll Need

• Bachelor’s degree
• At least ten (10) years of experience in revenue cycle management in healthcare in positions of increasing responsibility – working with commercial health insurance companies, Medicaid programs, and Medicare programs – required.
• Experience in revenue cycle management in behavioral health preferred.
• Experience with value-based care payment arrangements preferred.
• Demonstrate comprehension of payer contracts, with special attention to complexities and details.
• Problem-solving skills in order to identify problems, evaluate options and execute solutions.
• Must have relevant healthcare industry knowledge and market awareness.

Why Forge?

The opportunity:

Our team refuses to compromise on integrity, and we look for talented, driven hard workers who hold the same passion for the pursuit of high quality, evidence-based mental health and substance use care that we do. Our collective passion is driven and embodied by our core values:

• Fulfilling: Our work creates lives that are complete and self-actualized, enabling stronger families and communities – and a therapeutic community rewarded by success
• Optimistic: Our passionate positivity and empathy overcome setbacks and get you to your goals, scientifically and humanely
• Reciprocal: Without mutual trust and commitment, there can be no progress
• Grateful: We profoundly recognize and appreciate the trust of our patients and the commitment of our clinicians
• Evidence-Based: We are committed to measurable outcomes, which provide confidence to our patients and creates a standard of care for ourselves and others

The package:

At Forge, our people are our greatest asset. We’re collaborative, empathetic, and passionate. We learn from our mistakes, we carve out time to breathe, and we are celebrated for our wins. In short, we know that we can’t do what we do without you! So, we designed a comprehensive, competitive benefits package that reflects our appreciation of our people:

• Competitive salary aligned with your experience
• Comprehensive paid time off package
• Annual time off to volunteer
• Parental leave
• Annual continuing education allocations
• Competitive medical, dental, and vision package 
• Annual subscription to a leading meditation app
• An environment that fosters professional development including financing for advanced licensure and certifications
• Internal supervision opportunities
• Dedicated, motivated team and chance to be part of a highly ambitious medical startup
• Modern, elegant, and high-end work environment

We are committed to equal employment opportunity. We give equal consideration to all applicants when filling positions without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, actual or perceived disability, genetic information, marital status, and/or any other status not related to an applicant’s ability to perform the job duties. All employment practices will be carried out in accordance with federal, state and local laws.
We will also fully comply with regulations and requirements set out by the Americans with Disabilities Act (ADA) and the ADA amendments Act (ADAAA). We will not discriminate against applicants or other individuals with real or perceived disabilities. When needed, we will provide reasonable accommodation to otherwise qualified candidates so that they are able to perform the essential functions of the position.