Director of RCM Operations

Description

 The Director of Revenue Cycle will be responsible for optimizing revenue capture, ensuring timely and accurate billing and collections, and maximizing reimbursement while maintaining compliance with regulatory requirements. The ideal candidate will have a strong background in revenue cycle management, excellent leadership skills, and a commitment to achieving financial excellence in healthcare.

Responsibilities:

• Revenue Cycle Oversight: Provide strategic leadership and direction for the revenue cycle department, including billing, coding, collections, and accounts receivable management. Develop and implement policies, procedures, and best practices to optimize revenue cycle processes and improve financial performance. Monitor key performance indicators (KPIs), revenue metrics, and financial benchmarks to assess revenue cycle performance and identify opportunities for improvement.
• Billing and Claims Management: Oversee the billing process, including charge capture, claims submission, and revenue recognition, to ensure accurate and timely billing of services rendered. Monitor claim denials, rejections, and appeals, and implement strategies to minimize claim errors and maximize clean claim submission rates. Ensure compliance with billing regulations, coding guidelines, and payer requirements to optimize reimbursement and minimize revenue leakage.
• Accounts Receivable Management: Manage accounts receivable processes, including payment posting, denial management, and accounts receivable follow-up, to reduce outstanding balances and improve cash flow. Analyze accounts receivable aging reports, identify trends, and implement strategies to reduce days in accounts receivable and optimize collections.
• Revenue Integrity and Compliance: Ensure compliance with healthcare regulations, billing standards, and payer policies related to revenue cycle management, including HIPAA, CMS, and other regulatory requirements. Conduct regular audits and reviews of revenue cycle processes, documentation, and coding practices to ensure accuracy, completeness, and compliance.
• Financial Analysis and Reporting: Generate and analyze financial reports, revenue cycle performance metrics, and key performance indicators (KPIs) to monitor financial performance, identify trends, and support decision-making. Prepare and present revenue cycle performance reports, variance analyses, and recommendations to senior leadership and stakeholders.
• Staff Leadership and Development: Lead and develop the revenue cycle team, providing guidance, training, and support to ensure a high level of performance, productivity, and professionalism. Foster a culture of accountability, collaboration, and continuous improvement within the revenue cycle department.

Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field required; Master's degree preferred.
• Minimum of 7-10 years of progressive experience in revenue cycle management, with at least 3-5 years in a leadership or managerial role.
• Must have Athena collector background and experience.
• Coding experience.
• Strong knowledge of revenue cycle processes, healthcare billing regulations, coding guidelines, and payer reimbursement methodologies.
• Experience with healthcare revenue cycle software systems (e.g., Epic, Cerner, Meditech) and financial reporting tools.
• Excellent analytical, problem-solving, and decision-making skills.
• Strong leadership, including past team management of both internal and external third-party teams.
• Successful experience with change management, and the ability to work both high level strategically and drive tactically to cover support with billing and coding.
• Effective communication, interpersonal, and negotiation skills.
• Demonstrated ability to drive process improvements, optimize revenue performance, and achieve financial goals.
• Athena reporting experience and experience in women's healthcare preferred but not required.