Director of Revenue Cycle Management

JOB SUMMARY:

The Revenue Cycle Director provides strategic leadership for third-party payer operations, driving efficiency, compliance, and revenue optimization. This role oversees specific third-party billing functions, claims, and collections processes, ensuring alignment with organizational goals. Success will be measured by improvements in clean claim rates, reduction in AR days, and enhanced payer denial strategies.

The ideal candidate will bring strategic leadership and collaboration skills with strong analytic and operational capabilities. This role will lead a team responsible for optimizing revenue cycle processes, ensuring timely reimbursement, and maximizing revenue for the organization. This role ensures that revenue cycle processes are efficient, compliant, and aligned with organizational goals, maximizing revenue and enhancing financial performance.

JOB RESPONSIBILITIES

Leadership

• Lead and mentor a team of third-party revenue cycle specialists and analysts to optimize billing, coding, and collections processes.
• Ensure employee engagement and provide support and guidance, allowing staff to meet career goals.

Strategic Vision

• Develop and implement revenue cycle strategies aligned with organizational objectives.
• Set measurable goals for AR reduction, clean claim rates, and payer compliance.
• Lead initiatives for automation and technology adoption in revenue cycle processes.
• Utilize change management techniques to support actions and influence.

Operational Excellence

• Oversee the revenue cycle processes for Medicaid, Medicare, managed care, and commercial payers.
• Oversee vendor operations, appeals and collections to ensure accuracy and timeliness.
• Monitor KPIs such as net collection rate and denial management performance.
• Collaborate with finance, IT, and clinical teams to optimize workflows.
• Assess current operations, offering recommendations for improvement and implementing new processes that drive revenue enhancement and cost reduction.

Compliance & Risk Management

• Ensure adherence to federal, state, and payer regulations.
• Maintain audit readiness and implement corrective actions as needed.
• Implement best practices and industry standards to streamline revenue cycle processes and improve financial performance.
• Manage vendor relationships and negotiate contracts to optimize revenue cycle performance.

• Bachelor's degree in Healthcare Administration, Business, Analytics, or equivalent experience.

• 10 years of progressive revenue cycle leadership experience.
• Direct experience with claims analytics, denial management, payer compliance, and revenue cycle systems. Familiarity with Xifin billing system a plus.
• Proven record of implementing process improvements and improving KPI's.
• Extensive knowledge of Medicaid, Medicare, and commercial payer adjudication and appeal processes.
• Experience managing remote teams and implementing change management frameworks (Lean/Six Sigma knowledge preferred).
• Advanced skills with Microsoft applications which may include Outlook, Word,
• Excel/Smartsheet's, PowerPoint and other web-based applications.
• Experience with laboratory billing preferred.
• Previous staff management experience needed. Demonstrated strong leadership and team development skills.
• Excellent financial acumen, analytical and problem-solving abilities.
• Thorough understanding of healthcare reimbursement and denial management processes.
• Ability to adapt to evolving payer requirements and regulatory changes.
• Clear, concise communication skills and comfortable explaining complex findings to non-technical stakeholders.
• Highly organized, adaptable, and comfortable working in a dynamic, fast-growing environment.