Director, Revenue Cycle

Schedule: M-F 8:00a-5:00p on site

Key Functions

• Revenue Cycle Leadership

• Provides strategic leadership, direction, and oversight for all aspects of the revenue cycle, ensuring financial integrity and optimal reimbursement from patient registration through final account resolution. Develops and executes organizational revenue cycle strategies that support operational excellence, regulatory compliance, financial performance, and exceptional patient experience. Leads revenue cycle departments through continuous improvement initiatives and fosters a culture of accountability, collaboration, and innovation.

• Revenue Integrity and Charge Capture

• Provides high level oversight of the Charge Master, pricing strategies, and revenue cycle initiatives to maximize compliant reimbursement and minimize revenue leakage.

• Establishes organizational policies and standardized processes governing charge capture, coding compliance, and charge correction activities.

• Partners with clinical, operational, compliance, and clinician leadership to improve documentation quality, coding accuracy, and reimbursement outcomes.

• Oversees revenue integrity analytics to identify trends, monitor regulatory changes, and implement corrective action plans that improve revenue performance and compliance.

• Revenue Cycle Operations

• Provides strategic oversight for all revenue cycle functions, including but not limited to:

• Accounts receivable management

• Accounts receivable aging and cash acceleration

• Billing and collections

• Coding and documentation compliance

• Utilization review and appeals

• Contractual allowance management

• Denial prevention and appeals management

• Customer service and patient financial experience

• Payment posting and reconciliation

• Revenue cycle technology optimization

• Establishes organizational performance standards and monitors revenue cycle metrics to ensure achievement of financial, operational, and service excellence goals.

• Directs initiatives to improve data integrity, patient demographic accuracy, registration quality, and front-end revenue cycle performance.

• Develops, approves, and maintains revenue cycle policies, procedures, internal controls, and governance practices consistent with regulatory requirements and organizational objectives.

• Identifies opportunities to improve revenue capture, reduce avoidable write-offs, accelerate cash collections, and strengthen financial performance.

• Insurance, Third-Party Payors, and Contract Performance

• Provides executive leadership for strategic initiatives involving:

• Managed care contract performance

• Third-Party payer relationships

• Corporate client contracting

• Revenue optimization initiatives

• Collaborates with Finance and executive leadership to evaluate reimbursement methodologies, payer performance, and contract effectiveness.

• Oversees insurance-related operations, including:

• Insurance verification and authorization processes

• Reimbursement analysis and payment variance monitoring

• Payer relations and issue resolution

• Claims management and denial prevention strategies

• Patient financial services and customer satisfaction

• Partners with contracting, legal, and finance teams to improve reimbursement performance and mitigate payer-related financial risk.

• Strategic Initiatives and Process Improvement

• Develops and executes the organization's long-term revenue cycle strategy to support growth, financial sustainability, and operational excellence.

• Leads enterprise-wide performance improvement initiatives utilizing Lean, PDSA, Six Sigma, or other quality improvement methodologies.

• Identifies opportunities for automation, workflow redesign, and technology enhancements that improve productivity, compliance, and financial outcomes.

• Sponsors cross-functional initiatives that improve revenue cycle integration across clinical, operational, financial, and information technology departments.

• Evaluates emerging industry trends, regulatory changes, and best practices to continuously strengthen organizational revenue cycle performance.

• Financial Reporting, Analytics, and Performance Management

• Establishes and monitors enterprise revenue cycle key performance indicators (KPIs), dashboards, and scorecards.

• Provides executive reporting and financial analysis to senior leadership regarding revenue cycle performance, reimbursement trends, cash collections, denial management, accounts receivable performance, and revenue integrity.

• Utilized advanced analytics to identify operational risks, financial opportunities, and strategic recommendations for executive decision-making.

• Develops revenue forecasts and participates in organizational budgeting, financial planning, and long-range strategic initiatives.

• Oversees regulatory reporting requirements, including participation in the AHA survey and other external reporting as required.

• Serves as the revenue cycle executive liaison during annual financial statement audits and other regulatory or payer audits.

• Leadership and Organizational Development

• Provides leadership, coaching, and strategic direction to departmental leaders.

• Promotes collaboration across Finance, Clinical Operations, Information Technology, Compliance, Patient Access, Health Information Management, and executive leadership.

• Establishes a culture of accountability, continuous improvement, innovation, customer service, and operational excellence.

• Ensures departmental compliance with organizational policies, regulatory requirements, accreditation standards, and ethical business practices.

• Develops departmental operating and capital budgets and maintains fiscal accountability for assigned areas.

Experience Required: Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Nursing, or a related healthcare field.

Education Preferred: Master's degree in Healthcare Administration, Business Administration, Public Health, Finance, or a related field.

License/Certification Preferred:

• Certified Revenue Cycle Representative (CRCR)
• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)
• Other relevant AHIMA, AAPC, HFMA, or healthcare financial management certifications.

Experience Required:

Minimum of ten (10) years of progressive healthcare revenue cycle experience, including at least five (5) years of leadership experience directing multiple revenue cycle functions within a hospital or integrated health system.

Demonstrated expertise in revenue integrity, patient financial services, managed care reimbursement, billing, coding, collections, denial management, regulatory compliance, and financial performance improvement.

Proven success leading organizations, developing high-performing teams, implementing technology and process improvements, and partnering with executive leadership to achieve strategic and financial objectives.

Strong analytical, financial, communication, and leadership skills required.