Director of Revenue Cycle

Mason District Hospital•Havana, IL

3d•$84,300 - $97,700•Onsite

About The Position

The Director of Revenue Cycle is responsible for the strategic leadership, operational oversight, regulatory compliance, and financial performance of all revenue cycle functions for Mason District Hospital and affiliated Rural Health Clinics. The Director oversees Patient Access, Hospital Billing, Accounts Receivable, Insurance Follow-Up, Denials Management, and vendor-supported clinic billing operations to ensure accurate reimbursement, exceptional customer service, regulatory compliance, and optimal financial outcomes. This position develops and implements revenue cycle strategies that improve cash flow, reduce denials, strengthen revenue integrity, enhance operational efficiency, and support the financial health of the organization.

Requirements

Bachelor’s degree in healthcare administration, business administration, finance, accounting, or related field required.
Minimum three (3) years of supervisory or management experience required.
Minimum five (5) years of progressive healthcare revenue cycle experience required.
Experience with hospital billing, patient access, accounts receivable, reimbursement, and revenue cycle operations required.
Strong knowledge of healthcare regulations for CAH and RHC, including coding practices, insurance requirements, and HIPAA regulations.
Excellent communication and interpersonal skills, with the ability to interact with staff, patients, and external stakeholders.
Strong problem-solving skills and ability to handle complex issues under pressure.
Proficiency in electronic health records (EHR/TruBridge) and revenue cycle management software, as well as, Microsoft Office Suite (Word, Excel, Outlook, Teams)

Nice To Haves

Master’s degree preferred.
HFMA Certified Revenue Cycle Representative (CRCR), HFMA Certified Healthcare Financial Professional (CHFP), or other applicable healthcare finance or revenue cycle certifications preferred.
Experience managing clinic billing operations or revenue cycle vendors preferred.
Experience in a Critical Access Hospital and/or Rural Health Clinic environment preferred.

Responsibilities

Provides leadership and direction for all assigned revenue cycle operations.
Directly supervises Patient Access Supervisor, Hospital Billing Supervisor, and clinic billing representative.
Establishes departmental goals, objectives, and performance expectations.
Coaches, mentors, and develops supervisors and staff.
Conducts performance evaluations and addresses employee performance concerns.
Creates a culture of accountability, professionalism, service excellence, collaboration, and continuous improvement.
Establishes and maintains departmental standards, workflows, policies, procedures, onboarding programs, training materials, competency assessments, and performance expectations for all areas of responsibility to ensure operational consistency, regulatory compliance, effective employee development, and continuity of operations.
Participates in workforce planning, succession planning, recruitment, onboarding, and retention efforts.
Directs revenue cycle operations from patient access through final claim resolution and payment posting.
Establishes operational priorities and accountability measures to ensure revenue cycle performance aligns with organizational financial goals.
Oversees patient registration, insurance verification, prior authorization processes, financial clearance activities, hospital billing, accounts receivable follow-up, denials management, and collections processes.
Implements corrective action plans when performance targets are not achieved.
Utilizes operational and financial performance data to identify trends, establish improvement priorities, and drive achievement of departmental and organizational revenue cycle goals.
Identifies opportunities to improve reimbursement, reduce denials, and increase operational efficiency.
Collaborates with clinical, operations, and financial leaders to optimize revenue cycle workflows.
Maintains accountability for revenue cycle key performance indicators.
Analyzes trends and develops strategies to improve financial performance.
Develops, maintains, and updates the internal item master and coding with assistance from outside vendors, department leaders, and CMS website.
Assists with audit requests, reimbursement reviews, and Medicare cost report support activities.
Assists with payor enrollments and provider validations using ICAHN vendor and governmental websites.
Develops and implements internal controls that promote billing accuracy and revenue integrity.
Ensures departmental compliance with applicable federal, state, payer, and organizational requirements, including Medicare regulations, Illinois Medicaid (HFS) requirements, Medicare Advantage and Managed Medicaid requirements, Commercial payer and contractual obligations, Critical Access Hospital reimbursements, Rural Health Clinic billing and reimbursement requirements, CMS Conditions of Participation, HIPAA Privacy and Security requirements, Hospital Price Transparency regulations, and No Surprises Act requirements.
Maintains knowledge of changing healthcare reimbursement regulations and industry best practices.
Supports organizational compliance initiatives related to OIG Compliance Program Guidance, the Federal False Claims Act, billing compliance, fraud, waste and abuse prevention, audit readiness, and revenue integrity.
Collaborates with leadership, compliance personnel, auditors, and consultants to ensure audit readiness and regulatory compliance.
Serves as the primary organizational liaison for outsourced clinic billing services.
Oversees vendor-supported billing operations for three RHC clinics and any future affiliated clinic operations.
Monitors vendor performance, service levels, operational metrics, and contractual obligations.
Coordinates issue resolution between hospital leadership, clinic leadership, staff, and billing vendors.
Ensures clinic billing operations align with organizational expectations, reimbursement requirements, and regulatory standards.
Supervises employees assigned to support outsourced clinic billing operations.
Maintains operational readiness to ensure continuity of clinic billing services during vendor transitions, service interruptions, or contract termination, including responsibility for planning, coordinating, and overseeing the transition of clinic billing functions to direct hospital management if necessary.
Provides strategic oversight of Patient Access operations through the Patient Access Supervisor.
Ensures effective registration, insurance verification, financial clearance, and patient access processes.
Monitors operational and quality metrics and supports continuous improvement initiatives that enhance patient experience and reduce preventable denials.
Participates in annual departmental budgets for Business Office and Patient Access.
Prepares and presents departmental reports, performance metrics, and operational analyses.
Provides recommendations to executive leadership regarding staffing, technology, workflow design, and revenue enhancement opportunities.
Participates on committees, workgroups, and leadership teams as assigned.
Develops and maintains positive, professional working relationships with patients, visitors, physicians, employees, volunteers, vendors, auditors, regulatory agencies, community partners, and other stakeholders.
Performs other duties and assumes additional responsibilities as assigned to support departmental operations, organizational priorities, regulatory compliance, patient care, and the mission of Mason District Hospital.