JOB SUMMARY:
The Sr. Director of Revenue Cycle is responsible for overseeing revenue cycle management including coding, billing, collections, and denial management. This position must have a thorough understanding of the entire revenue cycle process and provide leadership as well as partner with other leaders within the organization. This position will drive performance improvement and revenue enhancement opportunities, and as a subject matter expert they will assist in providing strategy, decision support, organization planning, and operational leadership to optimize productivity, quality and overall company revenue.
RESPONSIBILITIES:
• Oversee and manage entire revenue cycle including billing, coding, collections, and denial
• management.
• Manage, develop, and mentor all revenue department staff, including billers and coders and
• RCM Supervisors.
• Provide up to date education for clinical, billing, and coding staff on coding trends.
• Develops, evaluates, implements, and revises policies and procedures related to billing,
• coding, reimbursement activities and improvement strategies.
• Reconcile all receivables and revenue reports and work closely with the finance department in
• the development of monthly financial reports.
• Conduct monthly analysis of Medicare/Medicaid/Third Party Payers to identify trends.
• Establishes annual financial goals and uses benchmarking to high performing systems to set
• annual targets in collaboration with the CFO.
• Responsible for the generation and management of revenue, productivity and metric reports
• Prepares and delivers reports regarding goals and objectives.
• Review and resolve issues related to claim generation and rejected/denied billings.
• Liaison with corporate team that oversees the processing of credentialing and provider enrollment applications, initial, and re-enrollment status with all Medicaid, Medicare, and Commercial Payors.
• Serve as a liaison within the company among departments and interact with outside vendors for the benefit of the organization.
• Commit to highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information. •
• Technical expert for Athena billing processes.
• Keeps abreast of all reimbursement billing procedures of third party and private insurance payers and government regulations.
• Monitors accounts sent for collection and reimbursements from insurance companies and other third-party payers.
• Reviews, monitors, and evaluates third party reimbursement and researches variances.
• Participates in the development of coding and billing strategies, evaluating process relative to revenue cycle, and making recommendations while ensuring compliance with any relevant rules or regulations (including HIPAA, Medicaid, Medicare, and specific 3rd Party Payors)
• Actively seeks opportunities to improve financial outcomes.
• Monitors and analyzes financial data and utilizes same for decisions regarding FTE's staffing and workflow.
• Creates business plan(s), justifying variances and analyzing cost benefit of programs. •
• Contribute to the success of TOC by providing leadership, direction and coordination of operations, finances and human resources for area of responsibility.
• Perform other duties or special projects as assigned
EDUCATION AND EXPERIENCE:
• Bachelor's degree preferred
• 10 or more years of direct relevant MSO experience within healthcare operations or consulting,
• Working knowledge of industry best practices; insurance verification, billing, charge capture, contractual adjustments, first and third-party reimbursement, lien filing processes, and cash management.
• Proven leadership, management, organizational skills, and experience with leading EHR and revenue cycle systems, including but not limited to Epic, Meditech and Cerner.
• Knowledge of federal, state, and local payroll laws and regulations
PREFFERRED QUALIFICATIONS & SKILLS
• Proven experience leading revenue cycle, CDI, coding, and HIM functions, including both hospital and professional fee domains, within a large, integrated health system.
• Deep knowledge of professional fee coding and billing, including physician documentation, CPT/HCPCS coding, and payer reimbursement models.
• Demonstrated success in strategic planning, cross-functional collaboration, and process transformation leveraging Lean or similar methodologies.
• Expertise in technology-enabled performance improvement, including automation, AI-assisted coding, and EHR optimization.
• Strong communication and relationship management skills with the ability to engage providers, executives, and operational stakeholders.
ORTHOPAEDIC SOLUTIONS MANAGEMENT IS A DRUG FREE WORKPLACE
We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
The Sr. Director of Revenue Cycle is responsible for overseeing revenue cycle management including coding, billing, collections, and denial management. This position must have a thorough understanding of the entire revenue cycle process and provide leadership as well as partner with other leaders within the organization. This position will drive performance improvement and revenue enhancement opportunities, and as a subject matter expert they will assist in providing strategy, decision support, organization planning, and operational leadership to optimize productivity, quality and overall company revenue.
RESPONSIBILITIES:
• Oversee and manage entire revenue cycle including billing, coding, collections, and denial
• management.
• Manage, develop, and mentor all revenue department staff, including billers and coders and
• RCM Supervisors.
• Provide up to date education for clinical, billing, and coding staff on coding trends.
• Develops, evaluates, implements, and revises policies and procedures related to billing,
• coding, reimbursement activities and improvement strategies.
• Reconcile all receivables and revenue reports and work closely with the finance department in
• the development of monthly financial reports.
• Conduct monthly analysis of Medicare/Medicaid/Third Party Payers to identify trends.
• Establishes annual financial goals and uses benchmarking to high performing systems to set
• annual targets in collaboration with the CFO.
• Responsible for the generation and management of revenue, productivity and metric reports
• Prepares and delivers reports regarding goals and objectives.
• Review and resolve issues related to claim generation and rejected/denied billings.
• Liaison with corporate team that oversees the processing of credentialing and provider enrollment applications, initial, and re-enrollment status with all Medicaid, Medicare, and Commercial Payors.
• Serve as a liaison within the company among departments and interact with outside vendors for the benefit of the organization.
• Commit to highest level of business and patient confidentiality possible adhering to all HIPAA and security guidelines when accessing and sharing patient information. •
• Technical expert for Athena billing processes.
• Keeps abreast of all reimbursement billing procedures of third party and private insurance payers and government regulations.
• Monitors accounts sent for collection and reimbursements from insurance companies and other third-party payers.
• Reviews, monitors, and evaluates third party reimbursement and researches variances.
• Participates in the development of coding and billing strategies, evaluating process relative to revenue cycle, and making recommendations while ensuring compliance with any relevant rules or regulations (including HIPAA, Medicaid, Medicare, and specific 3rd Party Payors)
• Actively seeks opportunities to improve financial outcomes.
• Monitors and analyzes financial data and utilizes same for decisions regarding FTE's staffing and workflow.
• Creates business plan(s), justifying variances and analyzing cost benefit of programs. •
• Contribute to the success of TOC by providing leadership, direction and coordination of operations, finances and human resources for area of responsibility.
• Perform other duties or special projects as assigned
EDUCATION AND EXPERIENCE:
• Bachelor's degree preferred
• 10 or more years of direct relevant MSO experience within healthcare operations or consulting,
• Working knowledge of industry best practices; insurance verification, billing, charge capture, contractual adjustments, first and third-party reimbursement, lien filing processes, and cash management.
• Proven leadership, management, organizational skills, and experience with leading EHR and revenue cycle systems, including but not limited to Epic, Meditech and Cerner.
• Knowledge of federal, state, and local payroll laws and regulations
PREFFERRED QUALIFICATIONS & SKILLS
• Proven experience leading revenue cycle, CDI, coding, and HIM functions, including both hospital and professional fee domains, within a large, integrated health system.
• Deep knowledge of professional fee coding and billing, including physician documentation, CPT/HCPCS coding, and payer reimbursement models.
• Demonstrated success in strategic planning, cross-functional collaboration, and process transformation leveraging Lean or similar methodologies.
• Expertise in technology-enabled performance improvement, including automation, AI-assisted coding, and EHR optimization.
• Strong communication and relationship management skills with the ability to engage providers, executives, and operational stakeholders.
ORTHOPAEDIC SOLUTIONS MANAGEMENT IS A DRUG FREE WORKPLACE
We are committed to maintaining a safe, healthy, and productive work environment. As part of this commitment, we operate as a drug-free workplace. All candidates will be required to undergo pre-employment drug screening and/or be subject to random drug testing in accordance with applicable laws and company policy.
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.