Director of Revenue Reimbursement

Key Responsibilities

• Lead the strategy and execution of revenue cycle operations, with emphasis on improving first-pass claim acceptance and reducing downstream rework.
• Drive automation and system optimization initiatives, prioritizing front-end process improvements that prevent denials before they occur.
• Evaluate current workflows and proactively identify opportunities to enhance auto-submission processes and overall efficiency.
• Collaborate closely with the VP of Finance to align on priorities, validate proposed process or system changes, and communicate improvement plans prior to implementation.
• Monitor and report on key performance indicators, including denial rates, clean claim rates, days in A/R, and productivity metrics.
• Interpret metrics effectively and translate insights into action.
• Identify root causes, implement process improvements, and develop staff through targeted training and coaching to achieve performance and productivity expectations.
• Lead, develop, and hold teams accountable for performance across all revenue cycle functions, including charge entry, coding, billing, A/R follow-up, and payment posting.
• Develop and maintain policies, procedures, and standardized workflows that support accuracy, compliance, and efficiency.
• Partner with internal departments to support system enhancements, data integrity, and workflow alignment.
• Ensure compliance with all regulatory requirements, including Medicare and other governmental payers.
• Continuously assess industry best practices and implement improvements that align with organizational goals.

Leadership Expectations

• Promote a proactive, solutions-oriented culture focused on prevention rather than rework.
• Communicate clearly, escalate risks early, and seek alignment before executing major changes.
• Balance innovation with operational practicality and system limitations.
• Build strong cross-functional relationships to support sustainable process improvements.

Experience

• Minimum 10 years working experience in healthcare revenue cycle management with at least 5 years of managerial experience.
• Medicare guidelines and healthcare claims regulation knowledge.
• Medicare Advantage claims adjudication is a plus.
• Experience with EMR software is a must.

Education

• Bachelor's Degree in a related field is preferred.
• In lieu of degree, 10 or more years of relevant experience.

Knowledge, Skills & Abilities

• Proficiency with computers and PC applications.
• Intermediate to advanced knowledge of Microsoft Excel and Office products.
• Possess extensive knowledge of billing regulations for Medicare, commercial, HMO's and PPO's.
• Knowledge of patient privacy and maintains confidentiality of all sensitive information.

Work Hours, Travel Requirements

• Monday - Friday, 8:00 a.m. - 5:00 p.m., and as needed to complete projects.
• Travel to medical offices may be necessary for the purpose of providing benefit education.

Working Conditions & Physical Requirements

• This job operates in an office setting.
• This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets and fax machines.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• While performing the duties of this job, the employee is regularly required to talk and hear.
• This is largely a sedentary role; however, some filing is required.
• This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary.
• Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.