Senior Director, Revenue Cycle

Position Summary

The Senior Director of Revenue Cycle provides operational leadership and strategic oversight for NeighborHealth’s revenue cycle functions, ensuring the effective management of billing, coding, accounts receivable, cash posting, credit balance resolution, and collections activities across the organization’s clinical service lines. This role is responsible for optimizing revenue cycle performance, ensuring compliance with federal and state billing regulations, and strengthening financial sustainability through improved reimbursement accuracy, denial management, and operational efficiency.

Revenue Cycle Operations

• Provide senior level leadership and oversight of all revenue cycle functions including charge capture, coding, billing, collections, payment posting, and accounts receivable management.
• Ensure timely and accurate submission of claims to third-party payers including MassHealth, Medicare, commercial insurers, and other payers.
• Monitor accounts receivable performance and lead initiatives to reduce days in AR, improve collection rates, and minimize write-offs.
• Oversee denial management processes including root-cause analysis, corrective action plans / appeal initiatives, and process improvement initiatives.
• Serve as the point person for payer contract management, including negotiation of reimbursement terms with third party payers to optimize revenue and minimize administrative burden.
• Lead payer contracting strategy, including negotiation of reimbursement terms with third party payers to optimize revenue and minimize administrative burden.
• Develop and monitor key revenue cycle performance metrics including clean claim rate, denial rate, days in AR, and net collection rate.
• Support organizational readiness for external audits, regulatory reviews, and HRSA operational site visits.

Revenue Optimization & Performance Management

• Conduct financial and operational analysis to identify revenue leakage and improvement opportunities.
• Lead initiatives to improve clinical documentation, charge capture accuracy, and claim submission efficiency.

Regulatory Compliance & Billing Integrity

• Ensure compliance with federal and state billing regulations, including Medicare, Medicaid, and MassHealth requirements applicable to Federally Qualified Health Centers.
• Maintain current knowledge of payer regulations, billing guidelines, and reimbursement methodologies.
• Coordinate internal and external billing and coding audits to ensure regulatory compliance and revenue integrity.

Cross-Functional Collaboration

• Partner with clinical, operational, and administrative leadership to ensure alignment between clinical workflows and billing requirements.
• Collaborate with Information Technology teams to implement system improvements, optimize billing workflows, and support regulatory changes.
• Work closely with department leaders to address incomplete encounters, documentation issues, and charge capture gaps.
• Provide training and educational resources to providers and staff on revenue cycle processes and compliance requirements.

Staff Leadership & Development

• Lead and develop revenue cycle staff through coaching, training, and performance management.
• Establish clear expectations, operational goals, and productivity standards for revenue cycle teams.
• Promote a culture of accountability, collaboration, and continuous improvement within the department.
• Support staff development through ongoing training and professional growth opportunities.

Payer Contract Management

• Lead payer contracting strategy, including negotiation of reimbursement terms with third party payers to optimize revenue and minimize administrative burden.
• Maintain a centralized inventory of all payer contracts, including fee schedules, key terms, and renewal timelines, ensuring accessibility and version control.
• Monitor contract compliance and payer performance, including reimbursement accuracy, denial trends, and adherence to contractual terms.
• Develop processes to identify and recover underpayments, leveraging analytics to compare expected vs. actual reimbursement.

Strategic Initiatives & Organizational Support

• Collaborate with the CFO and senior leadership to support financial planning, revenue forecasting, and reimbursement strategy.
• Assist with analysis of payer reimbursement methodologies and financial impact of regulatory changes.
• Participate in organizational initiatives related to new services, payer contracts, and operational improvements.
• Represent the organization in external meetings, workgroups, or industry forums related to revenue cycle operations.