DIRECTOR BILLING & ACCOUNTS RECEIVABLE OPERATIONS

Job Overview

The Director, Billing & Accounts Receivable Operations provides strategic and operational leadership for claim billing and third-party payer accounts receivable operations across the health system. The Director is accountable for ensuring timely, accurate, and compliant claim submission; optimizing insurance receivable performance; resolving reimbursement barriers; and achieving key revenue cycle and financial performance outcomes.

The Director leads institutional and professional billing operations, claim edit resolution, and payer accounts receivable follow-up while partnering closely with Denials Management to improve denial prevention, resolution, and root-cause remediation. This position collaborates across Revenue Integrity, Patient Access, Coding, Clinical Documentation Integrity (CDI), Managed Care, Finance, Information Technology, and operational leadership to accelerate reimbursement, reduce avoidable aging, minimize revenue leakage, and improve overall revenue cycle performance.

Success in this role is measured through key performance indicators including clean claim performance, claim submission timeliness, accounts receivable days, aging distribution, denial prevention and resolution effectiveness, productivity and quality, cash performance, and reduction of preventable write-offs.

The Director is accountable for strategic leadership, operational and financial performance, workforce development, regulatory compliance, stakeholder partnership, and continuous improvement across Billing and Accounts Receivable operations.

Job Requirements

Education

• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Health Information Management, or related field required.
• Master's degree in Healthcare Administration, Business Administration, Finance, Accounting, Health Information Management, or related field preferred.

Experience

• 7-10 years of progressive healthcare experience required; Revenue Cycle experience preferred.
• 5-7 years of leadership experience required, preferably within a complex healthcare or revenue cycle environment.
• 1-2 years' Experience with Epic Resolute Hospital Billing and/or Professional Billing operations preferred.

Knowledge, Skills & Abilities

• Strong knowledge of healthcare claim billing, reimbursement methodologies, payer adjudication processes, accounts receivable management, and denial prevention and resolution.
• Thorough understanding of Medicare, Medicaid, managed care, commercial insurance, governmental reimbursement requirements, CMS regulations, billing compliance requirements, and payer contract provisions.
• Strong analytical capabilities with the ability to interpret operational, financial, payer, and revenue cycle performance data and translate findings into actionable strategies.
• Demonstrated success leading large or complex operational teams through organizational change, process redesign, performance improvement, and transformation.
• Strong operational improvement, problem-solving, and process redesign capabilities.
• Working knowledge of Epic Resolute, payer portals, claim clearinghouses, reporting tools, and workflow management systems.
• Strong project management and change leadership capabilities.
• Excellent communication, presentation, relationship management, and executive reporting skills.
• Proficiency in Microsoft Excel, Word, and PowerPoint.

Preferred Certifications

• Certified Revenue Cycle Representative (CRCR), HFMA
• Certified Healthcare Financial Professional (CHFP), HFMA
• American Association of Healthcare Administrative Management (AAHAM) certification

Job Responsibilities

Strategic Leadership

• Develop and execute strategic and operational plans supporting organizational reimbursement, cash flow, and revenue cycle objectives.
• Provide leadership and direction to managers and operational teams responsible for institutional and professional billing and payer accounts receivable follow-up.
• Establish performance expectations, accountability measures, and leadership and professional development plans.
• Foster a culture of accountability, engagement, collaboration, continuous improvement, and operational excellence.
• Serve as a key Revenue Cycle leader and trusted advisor to executive leadership regarding billing, payer reimbursement, and accounts receivable performance.
• Anticipate emerging operational, reimbursement, regulatory, and payer-related risks and develop strategies to mitigate potential financial impact.
• Promote and model the TriHealth Way of Leading and TriHealth Way of Serving.

Billing & Accounts Receivable Operations

• Direct institutional and professional claim billing operations, including claim submission, claim edit resolution, and third-party payer follow-up.
• Ensure claims are submitted timely, accurately, and in accordance with regulatory, contractual, and payer requirements.
• Establish and monitor productivity, quality, service-level, and financial performance expectations.
• Lead strategies to reduce avoidable accounts receivable aging, accelerate reimbursement, and minimize preventable write-offs.
• Partner with Denials Management leadership to identify denial trends, strengthen prevention and resolution strategies, support appeals processes, and address upstream root causes.
• Collaborate with Revenue Integrity, Patient Access, Coding, CDI, Managed Care, Finance, Information Technology, and operational leaders to identify and resolve systemic reimbursement barriers.
• Develop, standardize, and maintain departmental workflows, policies, procedures, performance standards, and internal controls.
• Leverage data and analytics to identify performance gaps, prioritize opportunities, evaluate root causes, and implement sustainable operational improvements.

Financial & Performance Management

• Develop and manage departmental operating budgets in alignment with organizational financial objectives.
• Monitor labor expense, staffing, productivity, quality, cash, accounts receivable, and overall operational performance.
• Evaluate resource utilization and adjust staffing and operating models based on volumes, performance requirements, and changing business needs.
• Identify opportunities to improve efficiency and reduce cost while maintaining quality, service, compliance, and reimbursement integrity.
• Support organizational cash flow and revenue cycle goals through effective management of billing and accounts receivable operations.
• Establish performance reporting that clearly communicates trends, risks, root causes, financial impacts, and corrective actions.
• Present performance outcomes and improvement strategies to Revenue Cycle and executive leadership.

Workforce Planning & Leadership

• Determine staffing requirements, organizational structure, leadership resources, and capabilities necessary to achieve current and future operational objectives.
• Recruit, develop, mentor, and retain high-performing leaders and team members.
• Establish leadership development and succession plans that strengthen the Revenue Cycle leadership pipeline.
• Conduct performance management activities and ensure accountability for established operational, quality, and behavioral expectations.
• Promote employee engagement, professional development, continuous learning, and a culture of performance excellence.
• Lead teams effectively through organizational, technology, workflow, and process changes.
• Ensure compliance with organizational Human Resources policies and leadership practices.

Stakeholder & Payer Partnership

• Build strong, collaborative relationships with clinical, operational, financial, technology, and Revenue Cycle stakeholders.
• Communicate operational performance, financial risks, reimbursement barriers, and strategic priorities to key stakeholders and senior leadership.
• Support payer escalation strategies involving systemic reimbursement, claims-processing, contractual, or adjudication issues.
• Partner across functions to drive resolution of issues affecting claim submission, reimbursement, accounts receivable, denials, and cash performance.
• Present operational metrics, performance trends, financial impacts, risks, and improvement plans to Revenue Cycle and executive leadership.
• Participate in enterprise-wide initiatives supporting organizational, operational, and financial objectives.

Compliance & Risk Management

• Ensure Billing and Accounts Receivable operations comply with applicable federal, state, payer, contractual, and organizational requirements.
• Maintain appropriate operational controls supporting billing accuracy, reimbursement integrity, and prevention of inappropriate or avoidable write-offs.
• Identify, monitor, and mitigate operational and compliance risks associated with claim submission and payer receivable management.
• Support internal audits, external audits, payer reviews, and regulatory requests.
• Develop and oversee corrective action plans when operational, financial, or compliance risks are identified.
• Partner with appropriate compliance, legal, finance, and operational stakeholders to address identified risks and maintain sustainable controls.

Other Related Information:

Direct Report FTEs = 3-9 Indirect Report FTEs = 100-149 Work Environment: Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is performed in an office environment. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations. Able to effectively manage exposure to potentially infectious material per OSHA guidelines.

Working Conditions:

Bending - Rarely

Climbing - Rarely

Concentrating - Consistently

Continuous Learning - Frequently

Hearing: Conversation - Consistently

Hearing: Other Sounds - Frequently

Interpersonal Communication - Consistently

Kneeling - Occasionally

Lifting <10 Lbs. - Frequently

Lifting 50+ Lbs. - Rarely

Lifting <50 Lbs. - Occasionally

Pulling - Rarely

Pushing - Rarely

Reaching - Rarely

Reading - Consistently

Sitting - Frequently

Standing - Frequently

Stooping - Rarely

Talking - Consistently

Thinking/Reasoning - Consistently

Use of Hands - Consistently

Color Vision - Frequently

Visual Acuity: Far - Rarely

Visual Acuity: Near - Frequently

Walking - Frequently

Leadership Performance Standards

TriHealth leaders create a culture of engagement, safety & reliability and high performance by consistently modeling and utilizing the following TriHealth Way leadership competencies, tactics and ALWAYS Behaviors to drive strategic pillar results:

Achievement of Annual Pillar Goals:

1) Safety/Quality, 2) Service, 3) Growth, 4) Culture/People, 5) Finance

Leadership Competencies:

TriHealth Way of Leading

TriHealth Way of Serving

Transformation Change

Drive for Results

Build Organizational Talent

Leadership Tactics:

Conduct department huddles. Generally, clinical departments hold daily huddles, non-clinical hold weekly huddles.

Regularly Round on Team Members, using questions from the rounding log.

• 25 or fewer team members = monthly
• 26-50 team members = every other month
• 51+ (and optional team members) = quarterly

Lead monthly team meetings using meeting agenda template; review stoplight report; cascade key leadership messages.

Model, coach and validate team members use of TriHealth Way behaviors (AIDET + Promise, Always Behaviors and Always HEARD).

Recognize team members for safety wins, positive performance and demonstrating SERVE and ALWAYS behaviors, TriHealth Way of Leading, Serving and Delivering Care.