Director of Revenue Cycle

Planetree•Derby, CT

12d•Onsite

About The Position

The Revenue Cycle Director provides comprehensive strategic leadership and operational oversight for all functions of the hospital's revenue cycle. The primary goal is to maximize revenue integrity, enhance cash flow, and ensure proper and optimal reimbursement by overseeing accurate patient registration, efficient billing, denial optimization, and timely collections. This role is essential for maintaining strict compliance with all regulatory and payer requirements while improving the overall patient financial experience.

Requirements

Required: Bachelor's degree in Finance, Healthcare Administration, Business, or a related field.
Required: 7-12 years of progressive revenue cycle leadership experience in a hospital or large healthcare system, including 7+ years of dedicated management experience.
Required: Strong functional knowledge of coding regulations, complex payer requirements, and various reimbursement methodologies.
Expertise in key revenue cycle metrics (e.g., DNFB, A/R days, denial rates).
Exceptional leadership, communication, and change-management skills.
High analytical capability with a deep understanding of healthcare finance.
Proven ability to build and maintain effective working relationships across clinical, administrative, and financial teams.
Expertise in revenue cycle automation and technology is preferred.

Nice To Haves

Preferred: Experience with Meditech.
Strongly Preferred: Prior experience with Workers Comp and No-Fault processes.

Responsibilities

Develop and implement comprehensive, system-wide revenue cycle strategies encompassing patient access, coding, billing, and collections.
Lead and mentor managers and staff within all revenue cycle departments.
Establish and monitor key performance indicators (KPIs), dashboards, and performance targets (e.g., A/R days, denial rates, cash acceleration) to drive efficiency and financial outcomes.
Collaborate with executive leadership, physicians, and clinical teams to align revenue cycle operations with organizational goals and growth plans.
Assess revenue cycle operations to identify opportunities where technology or software can enhance productivity and reduce costs which includes implementing cost-effective strategies and technologies to improve financial performance, cash flow, and net revenue.
Ensure rigorous compliance with all federal and state regulations, CMS guidelines, and third-party payer policies while keeping abreast of all federal, state and third-party payer rules and regulations; apprises staff and the clinical departments of the Hospital.
Oversee revenue integrity initiatives, including charge capture accuracy, audit processes, and proactive denial management programs.
Manage strategic relationships with third-party payers to optimize contractual reimbursement and minimize preventable denials through root-cause analysis.
Monitor and enhance coding quality and documentation practices in partnership with HIM leadership.
Collaborate and communicate with the Managed Care team to ensure appropriate reimbursement and promptly address issues with managed care organizations.
Lead the coordination with managed care companies operations to resolve payment issues on billed accounts.
Direct all components of the revenue cycle, from scheduling and pre-authorization through claims submission, follow-up, and final collections.
Analyze processes to identify and resolve bottlenecks, risks, and opportunities for automation and workflow improvement.
Partner with clinical departments to ensure accurate charge capture and coding practices that optimize revenue.
Develop, manage, and monitor the annual budget for all revenue cycle departments, presenting financial trends and performance metrics to senior leadership and the board.
Plans, organizes, and oversees service delivery initiatives involving networking, integration, systems, security, data center, and related vendors in support of various Health System operations, projects and initiatives
Oversee the effective utilization of the Meditech billing platform, and analytics tools.
Partner closely with Information Services and IT to plan, organize, and implement system upgrades, new technologies, and workflow enhancements to ensure optimal system-wide best practices and data integrity.