Director of Revenue Cycle Operations

Altus Community Healthcare•Houston, TX

15h

About The Position

The Director of Revenue Cycle Operations runs day-to-day revenue cycle operations and is accountable for cash performance across collections, coding, billing, payment posting, denials, and payer disputes. The organization operates freestanding emergency departments primarily out of network, making accurate coding and documentation, timely supported claims, and resolution of payer disputes central to revenue performance. The Director owns the revenue cycle from charge capture through cash collected and leads a team of 15–20 through Associate Directors, managing through people and performance metrics. The Director reports results and risks to executive leadership with quantified impact and recommended actions, and may step in on complex disputes, backlogs, or staffing gaps. The role oversees revenue collections, revenue integrity, auditing, billing and charging workflows, revenue reconciliation, Chargemaster governance, denials, payment variances, and reimbursement processes. It provides leadership and subject-matter expertise for the No Surprises Act (NSA), Independent Dispute Resolution (IDR), Texas Department of Insurance (TDI) processes, payer disputes, and reimbursement negotiations. The Director establishes and reports KPIs, analyzes operational and financial data, ensures regulatory and policy compliance, develops the team, collaborates across organizational functions, and supports the Vice President of Revenue Cycle on strategic initiatives and special projects.

Requirements

Extensive healthcare revenue cycle experience, with demonstrated expertise in collections, denials management, reimbursement, payer negotiations, NSA, IDR, and TDI requirements.
Strong knowledge of healthcare billing, coding, reimbursement methodologies, charge capture, Chargemaster management, and revenue integrity practices.
In-depth knowledge of applicable healthcare regulations, privacy requirements, CMS guidelines, federal and state regulations, payer requirements, and healthcare billing standards.
Demonstrated experience analyzing claims, payment data, denials, and revenue cycle performance to identify trends, root causes, and opportunities for financial improvement.
Experience developing and implementing process improvements, internal controls, best practices, and revenue optimization strategies.
Demonstrated experience with payer negotiations, reimbursement disputes, payment variances, and resolving complex billing and reimbursement issues.
Strong analytical and problem-solving skills, including the ability to interpret complex financial and operational data and translate findings into actionable strategies.
Excellent written, verbal, communication, presentation, and interpersonal skills, with the ability to collaborate effectively with executive leadership, physicians, clinical teams, and operational stakeholders.
Demonstrated leadership experience and ability to build, mentor, and develop high-performing teams.
Proficiency with healthcare information systems, revenue cycle management platforms, patient access systems, billing systems, Chargemaster applications, reporting tools, and data analytics technologies.
Ability to manage multiple priorities, lead complex initiatives, and work effectively in a fast-paced, highly regulated healthcare environment.

Nice To Haves

Experience in a freestanding emergency department (FSED), emergency medicine, physician practice, or comparable healthcare revenue environment is strongly preferred.
Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or a related field preferred; equivalent education and relevant experience may be considered.

Responsibilities

Oversee revenue collections, the revenue integrity program, and auditing; coordinate strategic initiatives; and develop, implement, and update policies, procedures, and performance objectives.
Manage a team of 15–20 through Associate Directors, including staffing, training, development, performance management, and accountability within approved headcount.
Lead Associate Directors and oversee daily, weekly, and monthly monitoring and operational processes to support accurate billing, collections, complete charge capture, appropriate reimbursement, and revenue realization.
Evaluate and optimize charging and billing workflows to improve charge accuracy, completeness, timeliness, compliance, and reimbursement.
Monitor, validate, and reconcile revenue across clinical and operational departments, ensuring consistency among services provided, charges, claims, payments, and contractual reimbursement.
Assist with governance, maintenance, and optimization of the Chargemaster (CDM), including descriptions, CPT/HCPCS codes, revenue codes, pricing, billing requirements, and related charge components.
Partner with clinical and operational departments on revenue initiatives and advise on new Chargemasters, services, procedures, and charging methodologies.
Oversee collection, coding, payment posting, and reimbursement processes to prevent avoidable write-offs, underpayments, missed charges, billing errors, and other revenue leakage.
Provide strategic oversight of denials management, collections, and payment variance activities; work with Revenue Cycle leadership and clinical stakeholders to identify root causes and corrective actions.
Provide leadership and subject-matter expertise on NSA, IDR, TDI requirements, payer disputes, and reimbursement negotiations.
Own the dispute lifecycle, including open negotiation, determining applicable federal IDR or Texas TDI processes, offer strategy, filing deadlines, and award collection.
Track dispute outcomes by payer, including win rate, award as a multiple of the qualifying payment amount (QPA), and days to payment; escalate payers that fail to pay awards on time.
Establish, monitor, and report KPIs for charge capture and reconciliation, denials, collections, reimbursement, revenue leakage, pricing, payment variances, and revenue integrity.
Analyze financial, billing, claims, payment, and operational data to identify trends, opportunities, control weaknesses, and root causes.
Report weekly operating results and monthly performance to executive leadership, raising risks and opportunities early with quantified impact and recommended actions.
Ensure revenue cycle activities comply with CMS requirements, federal and state regulations, payer requirements, privacy laws, contractual obligations, and organizational policies and procedures.
Promote effective, consistent, integrated, and standardized revenue cycle processes, accountability, and operational transparency across the organization.
Lead, mentor, and develop a high-performing team, fostering accountability, collaboration, innovation, professional development, and continuous improvement.
Collaborate with Revenue Cycle leadership and stakeholders in Coding, HIM, Finance, Clinical Operations, Patient Access, Information Systems, and other areas to streamline workflows, eliminate duplicate efforts, strengthen controls, and improve performance.
Support the Vice President, Revenue Cycle on special projects and strategic initiatives involving new service lines, system implementations, organizational changes, acquisitions, regulatory changes, pricing initiatives, payer requirements, and other revenue-impacting activities.
Perform other duties and special projects as assigned.