DIRECTOR, REVENUE CYCLE MGMT

Director, Revenue Cycle Management

Summary/Objective

The Director of Revenue Cycle Management (RCM) is responsible for overseeing the entire revenue cycle process to ensure efficiency, compliance, and financial performance. This role collaborates with departmental and site leadership to optimize workflows and maintain process integrity. As a key member of the Management Team, the RCM Director supports the Chief Administrative Officer in achieving operational and financial objectives while safeguarding practice assets. Additionally, this position ensures timely and compliant execution of all accounts receivable functions.

Essential Functions

• Develop and implement strategic initiatives and operational plans to optimize reimbursement processes and billing services, ensuring efficiency, accuracy, and excellence in revenue cycle management.
• Establish, train for, and monitor expectations to fully support revenue goals.
• Identify specific billing and reimbursement projects, allocate resources, track progress, and take corrective action as needed.
• Establish, track, and report on key performance indicators (KPIs).
• Direct and oversee plans to ensure SOPs are in place for benefits investigations, appeals, and billing operations, ensuring adherence and issue resolution.
• Manage the billing and reimbursement team and verify that claims activity policies are followed.
• Responsible for safeguarding the financial assets of the organization.
• Oversee all areas of accounts receivable and assist with tasks when necessary.
• Maintain knowledge of insurance carriers medical policies.
• Maintain a strong working knowledge of the Electronic Medical Records (EMR) and Practice Management (PM) systems to oversee revenue cycle functions, optimize workflows, and support process improvements in collaboration with HIT leadership

Supervisory Responsibilities

• Support and guide the revenue cycle management (RCM) team, delegating operational tasks while overseeing departmental performance, resource allocation, and project execution to ensure financial and operational efficiency.
• Evaluate and optimize team workflows and staffing levels within the revenue cycle department to align with organizational needs, ensuring efficiency, compliance, and employee engagement.
• Positively manage employee relations, including coaching, performance evaluations, disciplinary actions, and conflict resolution, in accordance with company policies and industry best practices.
• Develop and maintain relationships between the revenue cycle department and external entities, including insurance payers, third-party vendors, government agencies, and financial institutions, to enhance reimbursement processes and operational effectiveness.
• Establish, train, and monitor expectations to support revenue goals.
• Manage the billing and reimbursement team, ensuring compliance with claims activity policies and presenting recommendations to Senior Leadership.
• Communicate and meet regularly with the accounts receivable team, facilitating necessary training and education.
• Oversee and conduct maintenance on the practice management system as needed, in conjunction with the Director of HIT.
• Continually work towards building and improving the accounts receivable team.
• Make recommendations to the Administrator to improve the accounts receivable process.

Other Duties/Responsibilities

• Promote the mission, vision, and values of Galen Medical Group.
• Represent the organization in a positive and professional manner.
• Adhere to HIPAA guidelines at all times to maintain patient confidentiality.
• Comply with all organizational policies and procedures.
• Participate in performance improvement and continuous quality improvement activities.
• Consistently demonstrate teamwork and collaboration.
• Communicate with the Administrator immediately regarding any accounts receivable, collections, and compliance concerns.
• Prepare weekly and monthly accounts receivable reports for the Administrator.
• Communicate in a timely and professional manner with insurance carriers.
• Effectively communicate with patients and staff concerning insurance and financial responsibility.
• Perform additional responsibilities as needed to support organizational goals.

Knowledge/Skills/Abilities

• Strong knowledge of medical billing rules, regulations, and payer requirements, including Medicare, Medicaid, and commercial insurance policies.
• Excellent communication and interpersonal skills, including conflict resolution, negotiation, and collaboration across departments.
• Expertise in revenue cycle management and financial reporting.
• Strong change management and process improvement expertise.
• In-depth knowledge of medical billing, collections, payment posting, revenue cycle operations, audits, Medicaid, and payer regulations (local and federal).
• Proficiency in CPT and ICD coding, HCFA 1500 forms, HIPAA compliance, billing and insurance regulations, medical terminology, insurance benefits, and appeal processes.
• Knowledge of business management and accounting principles to direct cash applications and financial oversight.
• Ability to handle sensitive financial and patient information with discretion and professionalism.
• Strong problem-solving skills to navigate complex insurance and billing issues.
• Ability to manage multiple responsibilities simultaneously while meeting deadlines.
• Complete assignments efficiently and in a timely manner.
• Understands and abides by OSHA, HIPAA & CLIA standards.

The above job description is intended to describe the general content and requirements for this job. It is not intended to be a complete statement of duties, responsibilities, or requirements.

Education

• A bachelors degree in business or a related field is required.
• A masters degree in business or a related field is preferred.
• Certified Professional Coder Certification through AAPC is preferred.

Experience

Minimum

• Eight (8) years of progressively responsible experience in medical insurance, healthcare billing, and collections within a multi-specialty medical practice (20 providers) or health system.
• Five (5) years of managing a team of medical biller/s collectors.
• Experience overseeing central business office functions, including revenue cycle operations, accounts receivable management, and payer contract compliance.

Preferred

• Ten (10) years of progressively responsible experience in medical insurance, healthcare billing, and collections within a multi-specialty medical practice (20 providers) or health system.

Galen Medical Group is a member of the Drug-Free Workplace, and it is a requirement that we conduct a pre-employment drug screen as part of the hiring process.