Director of Revenue Cycle

About the Role

The Revenue Cycle Director oversees revenue cycle management, including coding, billing, collections, and denial management. This position provides leadership, drives performance improvement, and enhances revenue opportunities. The Director partners with other leaders to optimize productivity, quality, and overall company revenue through strategy, decision support, organizational planning, and operational leadership.

Responsibilities

• Oversee and manage the entire revenue cycle, including billing, coding, collections, and denial management.
• Manage, develop, and mentor revenue department staff, including billers, coders, and RCM Supervisors.
• Provide up-to-date education for clinical, billing, and coding staff on coding trends.
• Develop, evaluate, implement, and revise policies and procedures related to billing, coding, reimbursement activities, and improvement strategies.
• Reconcile all receivables and revenue reports; collaborate with the finance department on monthly financial reports.
• Conduct monthly analysis of Medicare, Medicaid, and third-party payers to identify trends.
• Establish annual financial goals and use benchmarking to set targets in collaboration with the CEO and Sr. VP of Revenue Cycle.
• Generate and manage revenue, productivity, and metric reports; prepare and deliver reports on goals and objectives.
• Review and resolve issues related to claim generation and rejected/denied billings.
• Serve as a liaison with the corporate team overseeing credentialing and provider enrollment for Medicaid, Medicare, and commercial payors.
• Act as a liaison among departments and interact with outside vendors for organizational benefit.
• Serve as the technical expert for Athena billing processes.
• Stay abreast of reimbursement billing procedures for third-party and private insurance payers and government regulations.
• Monitor accounts sent for collection and reimbursements from insurance companies and other third-party payers.
• Review, monitor, and evaluate third-party reimbursement; research variances.
• Participate in developing coding and billing strategies, ensuring compliance with HIPAA, Medicaid, Medicare, and third-party payor regulations.
• Actively seek opportunities to improve financial outcomes.
• Monitor and analyze financial data to inform decisions on staffing, FTEs, and workflow.
• Create business plans, justify variances, and analyze cost-benefit of programs.
• Contribute to organizational success by providing leadership, direction, and coordination of operations, finances, and human resources.
• Perform other duties or special projects as assigned.

Requirements

• Bachelor’s degree required.
• 10 or more years of direct relevant MSO experience within healthcare billing operations.
• Working knowledge of industry best practices, including insurance verification, billing, charge capture, contractual adjustments, first and third-party reimbursement, lien filing processes, and cash management.
• Proven leadership, management, and organizational skills.
• Experience with leading EHR and revenue cycle systems, including AthenaOne, AthenaIDX, Epic, Meditech, and Cerner.
• Knowledge of federal, state, and local payroll laws and regulations.

Preferred Qualifications

• Proven experience leading revenue cycle, CDI, and coding functions, including professional fee domains, within a large, integrated health system or physician enterprise.
• Deep knowledge of professional fee coding and billing, including physician documentation, CPT/HCPCS coding, and payer reimbursement models.
• Demonstrated success in strategic planning, cross-functional collaboration, and process transformation using Lean or similar methodologies.
• Expertise in technology-enabled performance improvement, including automation, AI-assisted coding, and EHR optimization.
• Strong communication and relationship management skills, with the ability to engage providers, executives, and operational stakeholders.