Director of Revenue Cycle Management
Director of Revenue Cycle Management
General Summary:
The Director of Revenue Cycle Management (RCM) leads activities related to billing, collections, revenue integrity auditing, charge master management, claims management (denials and appeals), cash application, and other back-office functions. This role develops and implements strategies, processes, and technologies to optimize the revenue cycle in a fast-paced, high-volume healthcare environment.
Key Responsibilities:
- Analyze and validate revenue cycle reports to ensure data integrity for decision-making.
- Develop and execute strategies to improve billing efficiency and collections performance.
- Identify solutions to enhance collection rates, reduce bad debt, and lower days sales outstanding (DSO).
- Oversee performance metrics to refine RCM processes and reduce operational costs.
- Manage RCM projects, including audits, budgets, and technology enhancements.
- Supervise vendor relationships, ensuring quality, cost control, and process improvements.
- Support vendor-related projects and lead change management initiatives.
- Drive automation and process design improvements to enhance RCM efficiency.
- Ensure compliance with coding, billing regulations, and payer-specific requirements.
- Stay informed about regulations for third-party payers, including Medicare and Medicaid.
- Adhere to corporate compliance standards, healthcare regulations, and privacy laws (HIPAA).
Requirements:
- 5+ years of leadership experience in healthcare reimbursement (RCM).
- Extensive knowledge of healthcare industry standards, payer relations, and compliance regulations.
- Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field (flexible for strong candidates).
- Proficiency in large data analysis and financial modeling using Excel.
- Ability to generate reports in Power BI.
- Strong communication skills for presenting information to department leaders, physicians, and staff.
- Highly organized, with the ability to multi-task, work independently, and collaborate within a team.
- Commitment to employee engagement and development.
Preferred Skills:
- Physician billing experience.
- Experience managing or working with remote teams.
- Familiarity with eClinicalWorks software.
- Experience on the payer side (e.g., BCBS).