Director of Revenue Cycle Management

The Plus Group•San Rafael, CA

About The Position

We are seeking an experienced and strategic Director of Revenue Cycle Management to lead and optimize all aspects of the revenue cycle for a growing multi-site healthcare organization. This leader will be responsible for developing best-in-class revenue cycle processes that maximize reimbursement, improve cash flow, reduce denials, ensure regulatory compliance, and enhance the overall patient financial experience. The ideal candidate is an experienced healthcare revenue cycle leader with a strong background in Federally Qualified Health Centers (FQHCs), California reimbursement regulations, and multi-site healthcare operations.

Requirements

Bachelor's degree in Business Administration, Finance, Accounting, Healthcare Administration, Health Management, or a related field required.
Minimum of five years of progressive leadership experience managing healthcare revenue cycle operations.
Seven or more years of revenue cycle leadership within a multi-site California Federally Qualified Health Center (FQHC) strongly preferred.
Demonstrated success improving revenue cycle performance, reimbursement, collections, and operational efficiency.
Experience with payer contract negotiations and regulatory compliance.
Strong knowledge of the complete healthcare revenue cycle, including registration, coding, billing, collections, denials management, and reimbursement.
Comprehensive understanding of Medicare, Medi-Cal, CMS regulations, and California FQHC reimbursement methodologies.
Proven leadership experience managing exempt and non-exempt healthcare professionals.
Strong analytical skills with the ability to interpret financial and operational data to drive performance improvements.
Excellent written, verbal, presentation, and interpersonal communication skills.
Outstanding organizational, project management, and problem-solving abilities.
Ability to effectively manage multiple priorities in a fast-paced healthcare environment.
High level of integrity, professionalism, and accountability.
Demonstrated commitment to culturally competent care and serving diverse patient populations.
Strong computer proficiency, including Microsoft Office Suite (Excel, Word, Outlook), electronic health records (EHR/EMR), practice management systems, and revenue cycle software.

Nice To Haves

Master's degree (MBA, MHA, or related field) strongly preferred.
Certified Revenue Cycle Specialist (CRCS), Certified Revenue Cycle Professional (CRCP), Certified Revenue Cycle Executive (CRCE), or similar certification preferred.
Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or equivalent coding certification preferred.
Bilingual English/Spanish (written and verbal) is highly desirable.

Responsibilities

Develop, implement, and continuously improve revenue cycle policies, procedures, and operational systems that maximize reimbursement while maintaining compliance and minimizing billing errors, including: Patient registration, insurance eligibility, authorization, and benefits verification, Charge capture, coding accuracy, and charge entry, Claims submission, tracking, and resolution, Accounts receivable management, including denials, appeals, collections, and bad debt, Payment posting, reconciliation, and credit balance resolution.
Build strong partnerships across clinical, operational, and executive leadership teams to optimize revenue cycle performance.
Collaborate with the COO and Front Office leadership to strengthen front-end revenue cycle functions, including patient registration, documentation, insurance verification, and point-of-service collections.
Communicate regulatory, reimbursement, and revenue cycle updates throughout the organization.
Educate departments on how operational performance impacts revenue, cash flow, patient satisfaction, and overall organizational financial health.
Develop and present monthly revenue cycle performance reports, including KPIs, trends, variances, and improvement recommendations.
Analyze revenue cycle metrics and quickly identify issues affecting reimbursement or cash collections.
Ensure ongoing compliance with all applicable federal, state, and payer regulations.
Review, negotiate, and maintain favorable payer contracts, reimbursement methodologies, and payment terms.
Maintain expertise in Medicare, Medi-Cal, CMS regulations, and California FQHC reimbursement requirements.
Monitor reimbursement activity to ensure timely payment of all claims.
Develop proactive strategies to reduce denials and improve first-pass claim acceptance.
Implement corrective action plans to resolve payment delays and reimbursement issues.
Monitor regulatory changes and adjust revenue cycle processes accordingly.
Recruit, develop, mentor, and retain high-performing revenue cycle, billing, coding, registration, and financial counseling staff.
Establish measurable productivity, quality, and performance standards.
Provide coaching, education, and professional development opportunities.
Develop internal controls and workflows that improve efficiency, accountability, and compliance.
Ensure appropriate staffing levels while effectively managing scheduling, overtime, and daily operations.
Foster a culture of collaboration, continuous improvement, and exceptional customer service.