Description:
We are seeking a purposeful and operationally focused Director of Revenue Cycle Management (RCM)
Operations to oversee core revenue cycle functions and contribute to improvement in financial
performance. This leader will manage day-to-day operations, support compliance, and performance
improvement initiatives while fostering a collaborative team culture.
KEY RESPONSIBILITIES
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Operational Oversight: Manage daily revenue cycle activities including patient access, billing, collections, and reimbursement. Ensure consistent and compliant execution of revenue cycle processes.
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Team Leadership and Development: Supervise and mentor RCM staff and vendors to meet departmental goals utilizing best in class processes. Develop RCM training, process flows, standard operating procedure, set KPIs, and promote accountability and efficiency throughout the organization.
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Process Improvement: Identify opportunities to streamline workflows, reduce denials, and improve cash flow. Utilize business intelligence tools and data analytics to monitor and enhance performance.
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Stakeholder Collaboration: Work closely with finance, IT, clinical, and operational teams to support revenue cycle initiatives. Serve as liaison for resolving payer and provider issues affecting reimbursement.
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Vendor Oversight and Optimization: Assist in oversight of third-party vendors supporting revenue cycle functions, including billing, collections, coding, and eligibility. Supports adherence to service-level agreements (SLAs), compliance requirements, and performance standards.
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Payor Contract Analysis and Strategy: Assist with payor strategy and contract analysis to maximize reimbursement rates and streamline facilities billing processes.
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Credentialing and Payer Enrollment Oversight: Oversee credentialing and payer enrollment process to ensure timely onboarding of new providers, collaborating closely with clinical leadership and HR as needed.
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Performance Monitoring: Track and report on key performance indicators (KPIs). Identify trends and recommend improvements based on data analysis.
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Compliance and Quality: Support adherence to regulatory requirements and internal policies. Support external and internal audits as needed and continuous quality improvement efforts.
CORE COMPETENCIES
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Revenue Cycle Operations Management: In-depth knowledge of revenue cycle processes within healthcare settings.
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Team Leadership and Staff Development: Proven history in managing and developing teams in hybrid locations.
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Workflow Optimization and Performance Monitoring: Collaborate with cross functional teams, including finance, operations, IT, and clinical departments to streamline process and drive alignment across the organization.
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Payer Communication and Issue Resolution: Ability to perform analysis of physician and ancillary rates. Analyzes reimbursement and collections percentages vs. contracted rates. Lead fee schedule maintenance activities.
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Financial Reporting and Metrics Tracking: Strong analytical skills with the ability to collect, organize, analyze, and communicate information with a high degree of accuracy in a timely fashion.
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Compliance and Regulatory Knowledge: In-depth knowledge of healthcare regulations, compliance requirements and industry standards related to RCM.
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Change Management: Lead change initiatives related to new systems, acquisitions, or workflow redesigns in partnership with operational and clinical leadership.
Requirements:
- Bachelor's degree in healthcare administration, Business, or a related field. Master’s degree a plus.
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5+ years of experience in revenue cycle operations, preferably in a healthcare provider or hospital setting.
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Experience with Athenahealth or similar EMR and RCM platforms preferred.
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Demonstrated success managing teams and improving operational metrics.
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Proficient with healthcare revenue cycle systems and reporting tools.
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Effective communication and people skills.
