Director Revenue Cycle

Position Overview

OrthoMed Anesthesia is seeking a strategic, hands-on Director of Revenue Cycle Management (RCM) to lead and optimize all aspects of anesthesia billing operations.

Key Responsibilities

• Develop and implement RCM strategies to reduce days in A/R, improve cash flow, and minimize denials

• Oversee all components of the RCM process: billing, coding, charge posting, appeals, and patient financial services

• Monitor key performance indicators (KPIs) and produce actionable reports to inform decision-making

• Manage accounts receivable inventory management strategies, including prioritization frameworks, aging bucket oversight, and productivity benchmarks to maximize collections velocity and minimize revenue leakage

• Lead payer payment variance analysis, ensuring contractual underpayments are identified, documented, and recovered through systematic reconciliation of expected versus actual reimbursement across all payer contracts

• Lead comprehensive denial management and claims appeals programs, establishing root-cause analysis workflows, appeal letter standards, and escalation paths to reduce denial rates and maximize overturn success

• Drive revenue assurance initiatives and maintain expert-level knowledge of No Surprises Act (NSA) compliance, Independent Dispute Resolution (IDR) eligibility and jurisdictional requirements, and applicable state surprise billing regulations to protect net revenue

• Leverage technology solutions to enhance post-bill efficiency, including agentic AI tools for intelligent A/R prioritization and workflow automation, and automated appeals platforms to accelerate denial resolution and reduce manual intervention

• Lead, mentor, and scale a team of onshore and offshore RCM personnel

• Collaborate with credentialing, compliance, and IT teams to optimize workflows and integrations

• Serve as the internal expert on anesthesia billing regulations and payer-specific requirements

• Identify revenue trends and proactively address compliance risks

• Support internal audits, payer negotiations, and staff training initiatives

Required Qualifications

• Bachelor’s degree in Healthcare Administration, Finance, or equivalent professional experience

• Minimum 5 years of progressive RCM leadership, with a strong background in physician-based billing

• Deep understanding of CPT coding, ASA modifiers, concurrency rules, time documentation, and payer policies

• Knowledge of federal compliance standards, including CMS regulations

• Demonstrated experience designing and optimizing payment tracking and patient accounting workflows, including payment posting reconciliation, contractual adjustment controls, patient balance resolution, and financial clearance processes

• Working knowledge of or hands-on experience with agentic AI solutions for post-bill operations and automated appeals platforms, including AI-driven A/R work queues, intelligent denial routing, and automated payer correspondence

• Strong communication and analytical skills; experience with business intelligence (BI) tools is a plus

Preferred Qualifications

• AAPC, HFMA, or CRCM certification

• Experience with anesthesia-specific platforms (e.g., KAM, MedSuite, PPM, or PHI)

• Familiarity with Medicare, Medicaid, and major commercial payer billing guidelines

• Understanding of No Surprises Act (NSA), Independent Dispute Resolution (IDR), and Texas Department of Insurance (TDI) regulations

• Experience implementing or overseeing automated appeals management platforms and agentic AI tools integrated with anesthesia billing systems for denial resolution, payer correspondence, and post-bill workflow orchestration