Revenue Cycle Director

Southern Indian Health Council•Alpine, CA

2d•Onsite

About The Position

The Revenue Cycle Director oversees patient access, billing, coding, revenue collection, and related patient business services. The role works with ancillary departments and medical clinics to support clear communication and effective operations. It ensures accurate, timely, complete, and compliant charge capture; resolves pending charges; and oversees billing practices so Charge Description Master output aligns with payer requirements and organizational pricing strategies to support maximum reimbursement. The Director leads the Billing Department, including billing clerks, coders, and the Revenue Cycle Manager. The position oversees system and professional-fee coding and clinical documentation integrity (CDI), manages coding and CDI performance and quality programs, and supports compliance with applicable regulations and payer requirements. It also develops department goals, policies, procedures, and staff training; supports patient and staff resolution of billing issues; and collaborates with technical and clinical teams to improve systems, processes, and outcomes. Travel throughout the organization’s service area is required as needed, and a flexible schedule may be required based on need.

Requirements

Bachelor’s degree in business administration, healthcare administration, finance, accounting, or a related field.
At least 5 years of progressive experience in managed care operations, revenue cycle, or healthcare finance.
Strong background in claims processing, managed care contracting, financial performance management, and team leadership.
Proven success leading large teams and complex cross-functional projects in a healthcare setting.
Strong analytical skills and advanced computer skills.
Excellent communication and interpersonal skills.
Knowledge of change management, project management, continuous quality improvement, and billing and collections compliance for facility and professional fees.
Ability to manage, train, develop, and motivate subordinate staff.
In-depth working knowledge of ICD and CPT classifications and MS-DRG code groupers, with the ability to analyze and trend key metrics.
Ability to prioritize, meet deadlines, take initiative, and work proactively in a rapidly changing environment.
Ability to communicate clearly, address audiences effectively, exercise sound judgment, and work collaboratively with people of varied social and ethnic backgrounds.
Must be at least 18 years old.
Valid driver’s license maintained throughout employment; ability to travel throughout SIHC’s service area and to all site locations.
Current certifications and/or licenses appropriate to the required education and profession.
Reputation for honesty and trustworthiness; responsible judgment, confidentiality, attention to detail, and professional, courteous communication.
Must pass a pre-screening tuberculin skin test or x-ray and blood/urine drug screening; health must be adequate to perform the position’s duties.
Must complete and submit the SIHC application and authorization form to Human Resources before the stated closing date.

Nice To Haves

Certified Professional Coder (CPC) certification is preferred.

Responsibilities

Supervise Billing and Coding staff and the Revenue Cycle Manager, including hiring, performance evaluations, training, and identification of training needs.
Direct, administer, coordinate, and supervise patient business services functions and Billing Department operations.
Collaborate with technical staff to assess, design, create, modify, and troubleshoot systems supporting patient accounting and associated operations.
Monitor compliance with applicable regulatory requirements, including OIG and CMS, and promote compliance with payer and billing regulations.
Prepare annual department goals and objectives with subordinates, and develop short- and long-term goals with executive and departmental leaders.
Assist patients, physicians, and department personnel in resolving billing and collection problems.
Represent the department in internal and external Business Services meetings.
Develop system-wide policies and procedures to improve efficiency, reduce variation, and increase patient satisfaction.
Support optimization of clinic patient revenue and ensure charge capture is timely, accurate, complete, and compliant; resolve pending charges caused by provider delays or errors.
Oversee billing teams and ensure Charge Description Master output aligns with payer billing requirements and organizational pricing strategies.
Provide leadership and oversight for system and professional-fee coding and clinical documentation integrity (CDI).
Participate in developing objectives and strategies for integrating coded clinical information to support patient care, teaching, research, and resource management.
Serve as a coding subject matter expert for business operations and clinical committees.
Actively manage Discharged Not Billed work queues to ensure targets are consistently met.
Ensure appropriate staffing levels and adherence to fiscal targets.
Develop and manage coding and CDI performance indicators and metrics.
Develop and oversee quality assurance and productivity programs for coding and CDI staff.
Direct educational activities and coordinate ongoing CDI education for new staff, physicians, coders, nurses, and allied health professionals.
Provide input on coding, medical-record documentation guidelines, documentation standards, and related policies and procedures.
Oversee coding denial management activities.
Manage AI technology to improve work and revenue outcomes.
Travel throughout the organization’s service area and work a flexible schedule as needed.
Comply with SIHC policies and procedures and perform other duties as assigned.