General Summary: The Revenue Cycle Management Director provides strategic and operational leadership for the organization’s revenue cycle functions, with accountability for AR days, net collection rate, accurate revenue capture, timely month-end close support, clean AR aging, reconciliation analysis, and audit readiness. This role oversees billing, claims, payment posting, AR follow-up, denial management, revenue integrity, analytics, and related controls to improve cash flow, reduce avoidable write-offs, and support accurate financial reporting.
Job Responsibilities:
Leadership and Strategic Management
Provide leadership, direction, and oversight of all Revenue Cycle operations.
Set departmental goals, performance standards, and KPI targets aligned with organizational priorities.
Promote accountability, service quality, process improvement, and data-driven performance management.
Recruit, develop, mentor, and retain high-performing revenue cycle staff.
Establish and monitor staffing levels, workload distribution, productivity, and service standards.
Hold managers and staff accountable for AR follow-up, claims resolution, payment posting, productivity, and close deliverables.
Serve as the liaison between Revenue Cycle, Finance, Operations, Information Systems, and clinical programs.
Revenue Cycle Operations
Direct the end-to-end revenue cycle process, including:
Eligibility verification
Claims preparation and submission
Payment posting
Accounts receivable follow-up
Denial management
Appeals and recovery efforts
Refunds and credit balances
Revenue reconciliation
Ensure claims are submitted accurately and within payer-required timeframes.
Monitor claim lag, payment posting, denials, and payer issues to remove bottlenecks and support AR days below 40 days.
Oversee payer enrollment, credentialing coordination, EFT/ERA management, and billing system configuration.
Ensure consistent application of billing policies, coding requirements, reimbursement methodologies, and payer guidelines.
Establish and maintain standard operating procedures and workflow documentation.
Ensure billing, posting, follow-up, denials, and AR work queues meet established service levels.
Accounts Receivable and Collections
Maintain AR days below 40 days by reducing aged balances and improving collections.
Monitor AR aging, denials, collection effectiveness, bad debt exposure, and payer performance.
Develop corrective action plans for backlog reduction and revenue recovery.
Maintain a clean AR aging report with documented ownership, follow-up status, root causes, and resolution timelines.
Ensure timely resolution of denied, underpaid, and rejected claims.
Maintain net collection rate above 99% and bad debt write-offs below 1%.
Partner with operational leaders to resolve documentation, authorization, and billing issues impacting reimbursement.
Revenue Integrity and Financial Performance
Ensure complete and accurate revenue capture through charge review, billing validation, contract monitoring, and revenue leakage controls.
Provide analysis, schedules, and variance explanations for AR, deferred revenue, billing, cash, and general ledger reconciliations.
Complete revenue cycle month-end and year-end close deliverables accurately and on schedule with a target of 3rd business day.
Analyze reimbursement trends, payer performance, and contract compliance.
Review adjustments, write-offs, refunds, and credit balances for accuracy, authorization, financial impact, and policy compliance.
Support contract negotiations by providing reimbursement and financial analysis.
Data Analytics and Reporting
Work with Information Systems to maintain KPI dashboards for AR days, collection rate, bad debt, AR aging, denials, close readiness, reconciliation status, and audit support.
Report monthly KPI results, trends, variances, corrective actions, and responsible owners to executive leadership.
Utilize revenue cycle and EHR system data to identify operational improvement…