Associate Director- Revenue Cycle Hospital Billing

Guidehouse•San Antonio, TX

About The Position

The Hospital Billing Associate Director – Revenue Cycle oversees teams responsible for daily hospital billing operations and supports the timely, accurate, and compliant submission of facility claims. The role provides day-to-day leadership and technical guidance to billing staff; monitors productivity, quality, claim edits, and billing holds; and works with internal departments, payers, and clearinghouses to resolve issues affecting claim submission or reimbursement. The Associate Director is accountable for established billing goals and client service expectations while ensuring compliance with applicable federal and state regulations, payer requirements, and organizational policies. The role oversees claim generation, review, correction, and release; monitors work queues, unbilled accounts, electronic submissions, rejections, and billing exceptions; and ensures appropriate documentation and reconciliation. It identifies billing trends and root causes, implements process improvements and corrective actions, supports staff training and development, prepares operational reports, and communicates significant issues and recommendations to management. The position also collaborates with Patient Access, Health Information Management, Coding, Utilization Management, Revenue Integrity, IT, and other stakeholders, and supports audits and system or workflow changes.

Requirements

Bachelor’s degree and at least 10 years of relevant experience, or a high school diploma and at least 14 years of relevant experience.
At least four years of leadership, supervisory, or people-management experience.
Experience managing multiple facility posting data.
Knowledge of financial institution processes related to EFT conversion.
Extensive knowledge of blended payments, including hospital billing, physician billing, vendor payments, and general ledger transfers.
Hospital/facility billing or Patient Financial Services experience.
Strong understanding of hospital revenue cycle operations and accounts receivable.
Working knowledge of government and commercial payer billing requirements.
Ability to manage competing priorities and make timely operational decisions.
Ability to communicate effectively with staff, management, clients, payers, and cross-functional departments.

Nice To Haves

Extensive hospital billing experience.
Experience with Epic Hospital Billing (HB), Meditech 6, and/or Meditech Magic.
Experience managing claim edit and billing work queues.
Knowledge of Medicare and Medicaid hospital billing requirements.
Familiarity with CPT, HCPCS, ICD-10, revenue codes, claim forms, and hospital reimbursement methodologies.
Experience with billing scrubbers, clearinghouses, electronic claim submissions, and payer portals.
Experience developing or monitoring hospital billing KPIs and productivity standards.
Intermediate to advanced Microsoft Excel skills.

Responsibilities

Provide daily leadership, direction, coaching, and support to hospital billing staff, and promote a professional, collaborative, and accountable work environment.
Set expectations and monitor individual and team performance for productivity, quality, attendance, and operational KPIs; provide training, feedback, and development support.
Oversee daily hospital claim billing activities to ensure claims are generated, reviewed, corrected, and released accurately and within established timelines.
Monitor billing work queues, claim edits and holds, unbilled accounts, electronic claim submissions, payer rejections, clearinghouse edits, and billing exceptions through resolution.
Ensure staff resolve or route billing edits appropriately, document work in the patient accounting system, and follow corrected, replacement, and adjusted claim workflows.
Monitor claim reconciliation and investigate billing issues; work with payers, clearinghouses, internal departments, and other stakeholders to resolve recurring issues.
Monitor billing accuracy, quality, productivity, timeliness, inventory aging, and backlogs; perform or coordinate quality reviews and develop action plans to address performance gaps.
Identify root causes of recurring claim edits, rejections, and delays, and collaborate with stakeholders on corrective actions and sustainable process improvements.
Serve as an escalation point for complex billing issues and collaborate with revenue cycle departments, IT, system support teams, payers, and clearinghouses.
Communicate payer billing changes and requirements to staff and affected departments; support testing and implementation of system and workflow changes.
Ensure billing activities comply with federal and state regulations, payer requirements, and organizational policies; educate staff on billing and compliance expectations and escalate potential concerns.
Support internal and external audits and assist with corrective actions; ensure appropriate patient account documentation and adherence to authorization and adjustment policies.
Prepare, review, and distribute daily, weekly, and monthly billing reports; monitor billing productivity, turnaround time, unbilled accounts, claim holds, edits, rejections, quality, and accuracy.
Provide management with timely updates on billing barriers, backlogs, payer issues, operational trends, and risks; complete required reports, reconciliations, and projects accurately and on time.
Evaluate hospital billing workflows, maintain standardized procedures and training materials, encourage staff input, and support new technologies, payer requirements, system enhancements, and revenue cycle initiatives.