Director of Revenue Cycle

Director of Revenue Cycle

Provides operational oversight for the Billing, Authorization, and Eligibility Departments, and their respective functions. Collaborates closely with Finance, Clinical, and Operations Leadership to ensure efficient billing workflows and optimal cash flow.

The Director of Revenue Cycle will be responsible for driving performance improvements, strengthening internal controls, enhancing payer relationships, and implementing scalable processes to support the continued growth of our home health services. Simultaneously, the Director will ensure alignment with regulatory requirements, payer contracts, and organizational financial goals.

WHAT YOU'LL DO:

• Revenue Cycle Leadership

• Provide strategic oversight of Billing, Authorization, and Eligibility teams.
• Leads, mentors, and develops Billing, Authorization, and Eligibility managers and staff.
• Develop and implement revenue cycle policies, procedures, and performance standards.
• Drive continuous improvement initiatives to increase clean claim rates, reduce denials, and accelerate cash collections.
• Monitor KPIs including the overall collection rate, write-off and non-billable rates, authorization turnaround time, reimbursement trends, and coverage loss turnaround time.
• Partner with executive leadership to align revenue strategy with organizational growth goals.

• Billing Operations

• • Ensure timely and accurate billing submissions across Medicare, Medicaid and commercial payers in accordance with each of their requirements.
  • Oversee denial management processes, including root cause analysis and corrective action plans.
  • Maintain compliance with CMS billing regulations, Medicare/Medicaid billing rules, payer contract requirements, and Federal and state healthcare regulations.
  • Optimize reimbursement by identifying underpayments and resolving discrepancies.
  • Oversee billing functions including weekly billing process, cash posting, corrected claims, appeals, and reprocessing projects as needed.
  • Standardize billing workflows across states to ensure consistency and scalability.
  • Partners with the Billing Manager and the VP of Financial Strategy to reduce preventable billing errors. Supports net revenue forecasting and variance analysis.
  • Drives initiatives to improve cash flow, reduce the Unbilled, and AR aging.
  • Provides insight into billing trends, risks, and improvement opportunities to leadership.
  • Creates and manages self-pay contracts
  • Ensure readiness for audits and respond to external audit inquiries.
  • Implement internal audit protocols to proactively identify risk areas.
  • Collaborates with Compliance and Clinical teams to mitigate billing risk.

 Authorization & Eligibility Oversight

• • Ensure timely verification of insurance eligibility and benefits.
  • Oversee prior authorization processes to prevent missed authorizations.
  • Establish standardized workflows to reduce authorization delays and denials.
  • Collaborate with clinical and SCUM teams to ensure accurate documentation supports reimbursement.
  • Oversees coverage loss process to ensure expeditious reinstatement of patients’ insurance.

• Team Leadership & Development

• • Foster a culture of accountability, transparency, and continuous improvement.
  • Design staffing models to support growth and operational efficiency.
  • Provide ongoing training related to billing regulations and payer updates.

• Systems & Process Optimization

• • Oversee revenue cycle systems and recommend technology enhancements.
  • Utilize data analytics to identify revenue leakage and improvement opportunities.
  • Collaborates with IT, Informatics, and Revenue Cycle leadership on system configuration, upgrades, testing, and optimization. Drives automation and standardization to reduce manual intervention and rework.

• Performs other duties as assigned.