Revenue Cycle Director

Northeast Orthopaedic Alliance PLLC•Hingham, MA

3d•$80,000 - $100,000•Hybrid

About The Position

The Revenue Cycle Director provides strategic and operational leadership for the complete patient financial lifecycle at SSO. This role is accountable for timely and accurate charge capture, coding, claim submission, payment posting, denial prevention and resolution, accounts receivable, patient collections, payer performance, and revenue cycle reporting. The Director develops a high-performing team, partners with physicians and operational leaders, and uses data, technology, and disciplined workflows to improve cash flow, reduce avoidable revenue leakage, and ensure compliant reimbursement for professional, imaging, therapy, DME, surgical, workers' compensation, and other orthopaedic services. The position is initially dedicated to SSO, with the potential to expand into a broader multi-group revenue cycle leadership role as the organizational structure evolves.

Requirements

Bachelor’s degree in healthcare administration, business, finance, accounting, or a related field; significant directly relevant experience may be considered in lieu of a degree.
At least 5 years of progressive healthcare revenue cycle experience, including at least three years leading a substantial revenue cycle team.
Demonstrated command of professional billing, coding, denials, payer reimbursement, accounts receivable, patient collections, and revenue cycle analytics.
Experience working with commercial payers, Medicare, Medicaid/MassHealth, workers’ compensation, and other third-party payers.
Strong analytical skills and the ability to translate financial and operational data into clear decisions and accountable action plans.
Proven ability to lead change, develop staff, manage competing priorities, and influence physicians and others across functions.
Advanced proficiency with Athena or other practice management systems, electronic health records, reporting tools, and Microsoft Excel.

Nice To Haves

Revenue cycle leadership experience in a private orthopaedic, musculoskeletal, surgical, or other high-volume specialty physician practice; multi-site or multi-group experience is preferred to support potential future growth.
Experience with orthopaedic surgery, imaging, therapy, DME, injections, global surgical billing, and workers’ compensation.
CPC, CPMA, CRCR, CHFP, HFMA, or another relevant coding, compliance, or revenue cycle credential.
Experience leveraging evolving technology, standardizing workflows, overseeing outsourced billing or coding relationships, and supporting practice integration or scalable revenue cycle operations.

Responsibilities

Lead the end-to-end revenue cycle, including registration and eligibility controls, charge capture, coding, claim creation, billing, payment posting, denial management, accounts receivable follow-up, refunds, bad debt, and patient collections.
Translate SSO goals into annual revenue cycle priorities, staffing plans, productivity expectations, operating procedures, and measurable performance targets, with processes designed to support potential future multi-group growth.
Identify revenue leakage, reimbursement opportunities, workflow gaps, and root causes affecting cash flow; develop corrective action plans and hold team accountable for results.
Serve as the subject-matter expert on reimbursement, payer behavior, coding and billing operations, and revenue cycle risk.
Evaluate internal and outsourced revenue cycle functions and recommend the most effective structure, technology, staffing, and vendor support.
Ensure complete, accurate, and timely charge capture for office visits, procedures, surgeries, imaging, physical and occupational therapy, durable medical equipment, injections, and other ancillary services.
Oversee coding quality, claim edits, modifier use, global surgery rules, medical necessity, prior authorization dependencies, bundling, and documentation-related denials.
Partner with physicians, advanced practice providers, clinical teams, and coding staff to improve documentation and support compliant reimbursement.
Monitor payer-specific requirements and reimbursement trends for Medicare, Medicaid/MassHealth, commercial plans, workers’ compensation, motor vehicle, and self-pay accounts.
Coordinate coding audits and education; ensure identified risks and overpayments are escalated and corrected appropriately.
Direct insurance and patient accounts receivable activity, with clear ownership by payer, aging category, denial reason, and dollar value.
Establish a disciplined denial prevention and appeals program that addresses root causes rather than repeatedly reworking the same errors.
Monitor timely filing, clean-claim performance, underpayments, credit balances, unapplied cash, refund obligations, bad debt, and collection agency performance.
Ensure patient statements, payment plans, estimates, and collection practices are accurate, consistent, respectful, and compliant with applicable requirements.
Develop and maintain executive dashboards that provide accurate, actionable visibility into revenue cycle performance.
Report monthly results, trends, risks, corrective actions, and financial opportunities to executive leadership and other stakeholders.
Reconcile revenue cycle reports with Finance and support month-end close, cash forecasting, budgeting, audit requests, and financial analysis.
Use benchmarking and practice-specific data to set targets and evaluate team, payer, site, provider, service-line, and vendor performance.
Lead, coach, and develop revenue cycle managers, supervisors, coders, billers, payment posters, accounts receivable staff, and other assigned personnel.
Set clear performance expectations, conduct regular one-on-ones and evaluations, address performance concerns promptly, and develop succession and cross-training plans.
Establish staffing and productivity standards based on volume, complexity, automation, and organizational priorities.
Manage billing, coding, collection, payment, analytics, and technology vendors through defined service levels, scorecards, issue escalation, and contract accountability.
Optimize the practice management, electronic health record, payment, reporting, and related revenue cycle systems; ensure data integrity and effective work-queue design.
Standardize SSO policies and workflows while building scalable practices that can accommodate potential future expansion into a multi-group structure.
Maintain current knowledge of CMS, MassHealth, commercial payer, HIPAA, coding, billing, and reimbursement requirements applicable to the practice.
Collaborate with Compliance, Finance, Operations, IT, clinical leadership, and Human Resources on audits, investigations, training, system changes, and organizational initiatives.
Lead continuous-improvement initiatives that reduce manual work, increase first-pass resolution, shorten payment cycles, and improve the patient financial experience.