What are the responsibilities and job description for the Sr. Director - Revenue Cycle Management position at Astrana Health?
Department: CORPORATE OFFICE
Location: 8880 W Sunset Rd, Suite 320, Las Vegas NV 89148
Compensation: $160,000 - $185,000 / year
We are seeking a results-driven Senior Director of Revenue Cycle Management to lead, optimize, and innovate our revenue cycle operations within a managed care and value-based care environment. This position is responsible for developing and managing key performance indicators (KPIs), structuring processes for automation, and fostering a culture of accountability and efficiency. The ideal candidate will possess deep expertise in coding, risk adjustment, and compliance, ensuring that financial performance is maximized while mitigating risk. Additionally, this role will integrate billing functions with value-based care metrics, HEDIS reporting, and risk adjustment strategies to enhance overall revenue performance and quality outcomes.
Our Values
- Put Patients First
- Empower Entrepreneurial Provider and Care Teams
- Operate with Integrity & Excellence
- Be Innovative
- Work As One Team
Strategic Leadership & Revenue Optimization
- Develop and execute strategic initiatives to maximize revenue, improve efficiency, and enhance financial performance.
- Oversee all aspects of the revenue cycle, including patient access, coding, billing, collections, and reimbursement, ensuring alignment with value-based care models.
- Implement structured workflows that support automation and drive seamless, scalable revenue cycle operations.
- Establish clear accountability frameworks, setting expectations for accuracy, speed, and performance metrics across the revenue cycle team.
- Define, track, and continuously improve key performance indicators (KPIs) such as:
- Days in accounts receivable (AR)
- Denial rates & first-pass resolution rates
- Net collection percentages
- Coding accuracy & compliance scores
- Risk adjustment factor (RAF) scores & HEDIS metric capture
- Use data-driven insights to identify bottlenecks, enhance workflow efficiency, and implement process improvements.
- Develop dashboards and reporting structures to ensure real-time performance tracking and operational transparency.
- Oversee and enhance coding processes to maximize reimbursement while ensuring compliance with federal, state, and payer guidelines.
- Establish a robust internal audit process for coding accuracy and proper documentation to minimize risk and prevent revenue leakage.
- Ensure processes align with risk adjustment strategies (HCC coding) and facilitate accurate HEDIS measure reporting to support value-based contracts.
- Monitor regulatory changes and payer policies, ensuring billing practices remain compliant and optimized for reimbursement.
- Lead workflow transformation initiatives to increase automation and reduce manual touchpoints across the revenue cycle.
- Implement technology-driven solutions, such as AI-powered coding, claim scrubbing, and automated appeals management, to streamline billing and collections.
- Partner with IT to enhance EHR integration and optimize data capture for coding, risk adjustment, and value-based reporting.
- Drive cross-functional process improvement initiatives to ensure a seamless revenue cycle from patient registration to final reimbursement.
- Analyze denial trends, categorize root causes, and implement strategies to reduce claim rejections and accelerate cash flow.
- Develop a standardized approach to appeals and follow-ups, ensuring maximum reimbursement with minimal administrative burden.
- Strengthen relationships with payers to resolve disputes, negotiate contracts, and streamline reimbursement processes.
- Foster a culture of accountability, speed, and results-driven execution within the revenue cycle team.
- Provide mentorship, coaching, and development opportunities to ensure staff proficiency in coding, billing, and revenue optimization best practices.
- Promote cross-departmental collaboration to ensure alignment between revenue cycle operations, finance, and clinical teams.
- 10 years of progressive experience in revenue cycle management, preferably within managed care, risk-bearing entities, or value-based care models.
- Deep understanding of medical coding (CPT, ICD-10, HCC risk adjustment), billing, compliance, and reimbursement.
- Experience managing value-based care revenue strategies, including HEDIS measures and risk adjustment capture.
- Strong track record of structuring workflows for automation and efficiency.
- Proven ability to develop, track, and drive improvement in KPIs that impact financial performance.
- Experience leading high-performance revenue cycle teams and fostering a culture of accountability.
- Expertise in billing system optimization and integration with electronic health records (EHRs).
- This role follows a hybrid work structure, requiring onsite presence at our corporate office at 8880 W Sunset Rd, Suite 320, Las Vegas, NV 89148 as well as field visits to clinic locations.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Salary : $160,000 - $185,000
