Director of Revenue Cycle

Core Responsibilities

• Own the full revenue cycle end-to-end: patient access and pre-authorization, charge capture and coding oversight, claims submission, payor follow-up, denial management, cash posting, and patient collections.
• Drive net collection rate to 96% or higher across the payor portfolio and maintain days in Insurance AR (>0) below 45 days, with a target glide path to 40 days as the organization scales.
• Manage clean claim submission rate above 95% on first pass; own the rework process for the 5% that come back and the root cause analysis that keeps it from happening twice.
• Establish and run weekly AR aging review with attention on the 60+ and 90+ buckets by payor; escalate aged claims through documented payor escalation paths.
• Lead denial management with categorical denial tracking (registration, authorization, coding, medical necessity, timely filing); set weekly working denial targets per FTE and report root-cause trends to the CFO monthly.
• Payor & Collections Management
• Own the payor relationship from a billing operations standpoint: provider enrollment, credentialing coordination with HR/Operations, contract performance monitoring against fee schedules, and underpayment recovery.
• Manage the collections allowances methodology in coordination with the Controller: reconcile billed gross charges to contractual adjustments and bad debt write-offs, validate reserve adequacy, and explain monthly variances against historical collection patterns.
• Run the patient collections function including statement cycles, payment plan administration, financial counseling coordination, and management of bad debt placement with outside agencies.
• Maintain compliance with payor contractual requirements, HIPAA, state and federal billing regulations, and any program-specific requirements (Medicare, Medicaid managed care plans, commercial payors) applicable to the organization's service mix.
• Systems, Reporting & Process Improvement
• Own the practice management and billing system from a revenue cycle operations standpoint. Drive system optimization, work queue configuration, edits and scrubber rules, and integration points with the GL.
• Build and maintain the revenue cycle KPI dashboard: net collection rate, gross collection rate, days in AR (>0 and >90), denial rate by category, clean claim rate, point-of-service collection rate, cost to collect.
• Produce monthly revenue cycle reporting to the CFO and the leadership team with the discipline of a financial report: actuals against targets, variance commentary, root-cause analysis on misses, and the operational actions tied to each.
• Lead process improvement initiatives across the cycle.
• Compliance & Audit Support
• Maintain compliance with payor contractual requirements, HIPAA, state and federal billing regulations, and any program-specific requirements (Medicare, Medicaid managed care plans, commercial payors) applicable to the organization's service mix.
• Support the annual financial statement audit on revenue cycle related testing: claims data extracts, AR aging reconciliations, contractual allowance support, and bad debt reserve validation.
• Coordinate with internal compliance and external coding audits; remediate findings on documented timelines.

Qualifications

• Bachelor's degree in Healthcare Administration, Business, Finance, or related field. Equivalent combination of relevant certifications and progressive RCM experience considered.
• 7+ years of progressive healthcare revenue cycle experience covering the full cycle: patient access through cash posting, with hands-on time in denial management and AR follow-up.
• 3+ years in a revenue cycle leadership role (Manager, Senior Manager, or Director-equivalent) at a healthcare provider organization. Multi-site provider experience strongly preferred.
• Demonstrated track record of improving days in AR and net collection rate at a previous organization.
• Candidates should be able to quantify what they inherited, what they delivered, and over what timeframe. Experience building or rebuilding revenue cycle processes at a growing organization. Candidates whose experience is limited to maintaining a mature, established RCM operation are not the right fit.
• Direct people leadership of teams of 5 or more across billing, AR, and collections functions.