Director, Revenue Cycle

Key Responsibilities

• Oversee all aspects of the revenue cycle, including intake, eligibility verification, coding, charge entry, claims submission, AR follow-up, denial management, and payment posting
• Establish and monitor KPIs such as days in AR, denial rate, first-pass resolution rate, and net collection rate
• Identify root causes of revenue leakage and implement corrective actions
• Ensure timely, accurate claims submission and reimbursement across all payer types
• Serve as the internal subject matter expert for Athenahealth practice management and billing workflows
• Configure and optimize system rules, edits, and reporting to maximize efficiency and clean claim rates
• Partner with IT and operations on enhancements, automations, and integrations
• Troubleshoot system issues and drive continuous improvement in platform utilization

Data Analytics & Reporting

• Leverage advanced Excel capabilities (pivot tables, XLOOKUP, Power Query) to analyze large datasets
• Build and maintain dashboards and reporting tools for leadership
• Translate complex data into clear insights and operational improvements
• Ensure data integrity across systems and reporting outputs

Process Improvement & Automation

• Design, document, and standardize SOPs across the revenue cycle
• Identify and implement workflow improvements to reduce manual intervention
• Drive scalable process enhancements that support organizational growth
• Establish measurable performance metrics and accountability standards

AI & Workflow Innovation

• Identify and implement AI-enabled tools to optimize revenue cycle processes (e.g., denial prediction, coding support, automation)
• Evaluate emerging technologies and vendors for efficiency and accuracy improvements
• Lead pilots and deployments of automation solutions that reduce administrative burden
• Develop a forward-looking roadmap for AI integration across revenue cycle functions

Compliance & Risk Management

• Ensure compliance with payer requirements, CMS guidelines, and regulatory standards (including HIPAA)
• Maintain accurate documentation and coding integrity
• Monitor audit outcomes and implement corrective actions

Leadership & Team Development

• Lead and develop teams across billing, coding, and AR functions
• Establish performance expectations and provide ongoing coaching
• Foster a culture of accountability, continuous improvement, and operational excellence
• Partner cross-functionally with clinical, operational, and finance leaders