Job Description

Responsible for overseeing all functions of the revenue cycle for assigned management services agreement (MSA) clinical groups and outsourced revenue cycle vendor relationships. This includes direct oversight of billing, coding, collections, denials management, and credentialing teams. The Revenue Cycle Director ensures policies, objectives, and initiatives support compliance and optimization of the patient financial experience across the care continuum. This role includes collaboration with the C-suite on critical revenue initiatives and leading all Revenue Cycle Management (RCM) staff.

• Maximize the organization’s financial performance by ensuring accurate, efficient capture, Oversee all aspects of the revenue cycle, including billing, coding, insurance verification, patient registration, charge capture, collections, and denials management.
• Coordinate vendor relationships and MSA clinical groups to ensure compliance with Federal, State, and local regulations.
• Collaborate with financial managers to monitor and improve processes related to claims submission, payment posting, appeals, and A/R follow-up.
• Develop, implement, and enforce policies and procedures that ensure efficient and compliant revenue cycle operations.
• Establish and monitor key performance indicators (KPIs) to track performance and identify areas for improvement.
• Lead and mentor revenue cycle staff, including billing specialists and coders, to ensure accuracy, accountability, and high-quality work.
• Partner with clinical and administrative leadership to ensure appropriate documentation and coding practices.
• Ensure adherence to HIPAA, Medicare/Medicaid, and commercial payer compliance requirements.
• Manage payer relationships and credentialing processes to support timely and accurate reimbursement.
• Conduct regular audits and risk assessments to ensure revenue integrity and mitigate compliance exposure.
• Recommend process improvements and lead initiatives to improve revenue capture and reduce claim denials.
• Coordinate with other departments (e.g., Compliance, IT, and Finance) to maintain accurate financial reporting.
• Maintain strict confidentiality of patient and organizational information.
• Participate in continuing education and remain informed on industry trends and best practices.

Competencies

• Analytical: Synthesizes complex information; uses data to drive performance.
• Communication: Communicates effectively in verbal and written formats; ensures appropriate stakeholder engagement.
• Leadership: Builds and leads high-performing teams; provides feedback and recognition.
• Problem Solving: Identifies issues and implements solutions; standardizes practices across multiple locations.
• Strategic Thinking: Develops and implements plans to meet long-term goals.
• Judgment: Makes informed decisions; includes stakeholders in decision-making.

Education and Qualifications 

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field required; Master’s degree preferred.
• Minimum of 7–10 years of progressive experience in healthcare revenue cycle management, including at least 3 years in a leadership or director-level role.
• Experience in surgical or multi-specialty physician practices preferred.
• Certification in Healthcare Financial Management (e.g., CRCR, CHFP, HFMA) is a plus.
• Strong knowledge of payer regulations, reimbursement methodologies, and compliance standards.
• Proficient in Microsoft Excel and Word; familiarity with EMR and revenue cycle software required.

Physical Requirements

• Typical office environment with moderate noise levels
• Requires prolonged periods sitting at a desk and working on a computer.
• Occasional standing, walking, stooping, and lifting (up to 20 lbs).
  • Travel required (20–50%).

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