Director, RCM

Description

POSITION:  Director of Revenue Cycle Management

RESPONSIBLE TO: Vice President of Financial Operations

JOB SUMMARY: The Director of Revenue Cycle will oversee and lead all aspects of our healthcare organization’s revenue cycle operations, including external 3rd party billing teams. The Director of Revenue Cycle will be responsible for driving strategic initiatives that maximize revenue, reduce costs, and improve overall financial performance. This role will involve collaborating with senior leadership, optimizing revenue cycle processes, ensuring compliance with regulations, and driving improvements in billing, coding, collections, and reimbursement.

RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:

• Leadership & Strategy: Lead and manage the entire revenue cycle function, including billing, coding, reimbursement, collections, and patient financial services. Develop and implement strategic plans to optimize revenue cycle performance.
• Revenue Optimization: Monitor and improve key performance indicators (KPIs) related to revenue cycle management. Identify opportunities to increase revenue, reduce denials, improve cash flow, and minimize accounts receivable aging.
• Financial Performance: Oversee financial reporting for the revenue cycle and work with finance and accounting departments to ensure accurate and timely reporting. Provide regular updates to executive leadership regarding the financial health of the organization.
• Compliance & Regulations: Ensure compliance with all healthcare regulations, billing practices, payer requirements, and insurance guidelines. Stay updated on industry trends and government regulations such as HIPAA, ICD-10, and CMS guidelines.
• Team Management: Lead, mentor, and develop a team of internal and external revenue cycle professionals. Foster a culture of accountability, excellence, and continuous improvement.
• Collaboration: Collaborate with clinical, IT, and administrative teams to streamline operations, improve workflows, and enhance the patient experience. Act as a liaison between various departments to resolve revenue cycle challenges.
• Technology Integration: Oversee the implementation and optimization of revenue cycle management technology, including electronic health records (EHR) and billing systems, to enhance efficiency and data accuracy.
• Denial Management: Lead efforts to identify and address denial trends, working to reduce denials and rejections. Develop and implement effective denial management strategies.
• Budget Management: Develop and manage the revenue cycle department’s budget, ensuring cost-effective practices while maintaining the highest level of service and quality.

OTHER

• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends all meetings as requested including regular staff meetings.
• Attends Medicare and other continuing education courses as requested.  Pursue and participate in education to remain current with changes in the Healthcare industry.
• Performs any additional duties as requested by executive leadership team and supervisor.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.

SUPERVISORY RESPONSIBILITIES

This position supervises the Revenue Cycle Management department.

TYPICAL PHYSICAL DEMANDS

This position is a full-time, director-level position.  Work is normally performed in a typical interior/office work environment.  No or very limited exposure to physical risk.  May require occasional travel to other locations as needed.

Qualifications

EDUCATIONAL REQUIREMENTS:

• Bachelor’s degree in healthcare administration, business, finance, or a related field.

QUALIFICATIONS AND EXPERIENCE:

• Experience: Minimum of 10 years of experience in healthcare revenue cycle management, with at least 5 years in a senior leadership role.
• Skills: Strong knowledge of healthcare billing, coding, payer requirements, and reimbursement processes. Proficient in revenue cycle management software and electronic health records (EHR) systems.
• Leadership: Proven ability to lead and motivate cross-functional teams, driving results through collaboration and strategic thinking.
• Communication: Excellent verbal and written communication skills, with the ability to effectively interact with senior leadership, staff, and external stakeholders.
• Problem-Solving: Strong analytical and problem-solving skills, with the ability to develop and implement solutions to complex revenue cycle issues.
• Knowledge of Healthcare Regulations: Deep understanding of healthcare regulations, payer contracts, and compliance requirements.