Director of Revenue Cycle Management

Chimes•Baltimore, MD

About The Position

The Director establishes enterprise visibility and accountability while adapting processes to the different reimbursement and contract models across the organization.

Requirements

Enterprise Revenue Cycle Leadership
Revenue Models & Payer Complexity
Service Capture, Documentation & Authorization
Billing, Claims & Invoicing
Accounts Receivable & Collections
Cash Application & Reconciliation Support
Denials, Underpayments & Revenue Leakage
Performance Management & Visibility
Cross-Functional Partnership
Vendors, Technology & Automation
M&A & Integration
Leadership & Enterprise Partnership

Responsibilities

Lead revenue-cycle strategy and execution across all operating businesses and revenue streams.
Establish common enterprise standards, controls, KPIs and operating routines while recognizing the different requirements of Behavioral Health, IDD, Schools, Employment Services and other programs.
Ensure effective processes across Medicaid and other third-party payers, county and government funding, fee-for-service arrangements, commercial and government contracts and other program revenue.
Maintain clear ownership and expertise for payer-specific, contractual and regulatory billing requirements.
Partner with Operations to ensure services delivered are captured completely and supported by required documentation, authorizations and other prerequisites for billing.
Identify upstream operational issues that prevent billing and establish escalation/accountability before they become revenue or cash problems.
Oversee the process from billable activity through claim submission or invoicing.
Establish billing calendars, completeness checks, quality controls and escalation processes.
Monitor billing lag, unbilled revenue, rejected claims/invoices and rebilling activity by business and payer.
Own enterprise AR performance and collections.
Segment receivables by business, payer, program and aging; establish collection strategies and escalation protocols for aged or high-risk balances.
Ensure material receivables have documented status, next steps and ownership rather than rolling forward without action.
Own timely and accurate cash application and reduction of unapplied/unidentified cash.
Ensure payment information is available to support AR integrity and partner with Accounting on reconciliations and month-end close.
Resolve systemic causes of unapplied cash rather than relying on repeated manual clean-up.
Own denial prevention and resolution, underpayments, avoidable write-offs and revenue leakage.
Use root-cause analysis to distinguish documentation/authorization, operational, payer, system and billing-process issues.
Quantify financial impact, assign corrective actions and track recovery or prevention.
Establish RCM scorecards and operating reviews by business, payer, program and revenue stream.
Provide clear visibility to service-to-bill timing, billing completeness, clean claims/invoices, denials, AR aging, collections, cash application and leakage.
Escalate material trends early.
Partner with Operations on service capture, documentation and authorization; with Finance on revenue economics, forecasting, expected collections and leakage; and Accounting on revenue recognition, AR integrity, reconciliations and financial-statement support.
Ensure issues move across these seams without becoming 'someone else’s problem.'
Manage third-party billing vendors to defined service levels and financial outcomes.
Lead RCM requirements for systems, reporting and automation and partner on Finance technology decisions affecting revenue.
Reduce manual touches and improve data quality without weakening controls.
Lead the RCM workstream for acquisitions and new affiliates.
Assess billing processes, payer relationships, AR quality, denials, systems and staffing during diligence.
Develop Day 1 and post-close integration plans and transition acquired businesses into enterprise RCM processes without disrupting billing or cash.
Build a Finance team that is accountable for both analytical quality and business outcomes.
Develop strong Finance partners who understand operations, challenge constructively and follow issues through to resolution.
Operate as part of one Finance team, actively partnering with Financial Performance, Revenue Cycle, Treasury and Operations rather than treating Accounting as a separate silo, and one shared services team, providing best in class customer service to our number one client, the operations team and clients we serve.