Revenue Cycle Management Director

Adobe Care And Wellness LLC•Phoenix, AZ

1d•Hybrid

About The Position

Adobe Population Health (APH) is a women-owned health solutions company founded in 2018 with a mission of positively impacting the lives we touch. Headquartered in Phoenix, AZ, with satellite locations across multiple states, APH fosters a culture rooted in inclusivity, human kindness, and high-quality care. Recognized by Inc. 5000 as one of America’s Fastest-Growing Private Companies and honored for a fifth consecutive year as a “Best Place to Work” by the Phoenix Business Journal, APH continues to expand its reach and impact. APH partners with health plans, providers, hospitals, and families to deliver tailored programs including case management, in-home and in-clinic wellness assessments, preventative care, transitional care, and social services. As one of the nation’s few fully integrated healthcare organizations, APH delivers comprehensive, coordinated medical and social support through a wide range of specialized service lines. With continued growth on the horizon, APH is seeking mission-driven individuals who are passionate about improving health outcomes and supporting those in need.

Requirements

Seven (7) years of progressive healthcare revenue cycle experience.
Three (3) years of leadership experience managing revenue cycle, billing, collections, or reimbursement teams.
Strong understanding of healthcare reimbursement methodologies, including Medicare, Medicaid, Medicare Advantage, commercial insurance, and value-based care payment models.
Demonstrated success improving accounts receivable performance, collections, denial rates, and reimbursement outcomes.
Experience analyzing financial and operational data to drive decision-making.
Strong project management and process improvement capabilities.
Exceptional leadership, communication, coaching, and relationship-building skills.
Ability to effectively collaborate with executive leadership and cross-functional teams.
Strong analytical, organizational, and problem-solving skills.
Ability to thrive in a fast-paced, rapidly growing healthcare environment.
Proficiency with revenue cycle systems, electronic health records, practice management systems, and Microsoft Office Suite.

Nice To Haves

Experience supporting population health, managed care, risk adjustment, or value-based reimbursement programs preferred.
Knowledge of HCC coding, risk adjustment methodologies, STARS, HEDIS, and quality incentive reimbursement models preferred.
Experience managing vendor relationships and outsourced revenue cycle services preferred.
Master’s degree in healthcare administration (MHA), business administration (MBA), finance, or a related field preferred.
Certified Revenue Cycle Executive (CRCE), Certified Healthcare Financial Professional (CHFP), Certified Professional Coder (CPC), Certified Professional Biller (CPB), or equivalent certification strongly preferred.
Lean Six Sigma certification preferred.

Responsibilities

Provide strategic oversight and leadership for all revenue cycle functions, including patient eligibility verification, charge capture, coding review, claims management, payment posting, collections, denial management, and reimbursement optimization.
Develop and execute revenue cycle strategies that align with organizational financial goals and growth initiatives.
Establish department objectives, performance standards, and key performance indicators (KPIs) that support operational excellence and financial performance.
Collaborate with executive leadership to identify opportunities to enhance revenue integrity and maximize reimbursement.
Develop annual departmental goals, budgets, staffing plans, and operational roadmaps.
Oversee all billing and claims submission activities to ensure timely, accurate, and compliant reimbursement.
Monitor claims lifecycle performance, including clean claim rates, first-pass resolution rates, days in accounts receivable, denial rates, and collection effectiveness.
Ensure appropriate billing practices are followed for Medicare, Medicaid, commercial payers, and value-based care contracts.
Lead initiatives to improve claim accuracy and reduce preventable denials.
Analyze reimbursement trends and implement corrective actions to improve collections and cash flow.
Develop and oversee comprehensive denial management programs.
Monitor denial trends and root causes to identify opportunities for process improvement.
Collaborate with operational and clinical leaders to resolve documentation, coding, and workflow issues impacting reimbursement.
Establish corrective action plans to address recurring revenue leakage and reimbursement challenges.
Ensure proper revenue capture through auditing, monitoring, and education initiatives.
Partner with Finance and Contracting teams to evaluate payer contracts and reimbursement methodologies.
Monitor payer performance and reimbursement compliance.
Serve as a key point of contact for payer escalations, reimbursement disputes, and operational concerns.
Analyze payer trends and identify opportunities to improve contract performance.
Support negotiations by providing operational and financial reimbursement insights.
Collaborate with Quality, Clinical Operations, and Population Health leadership to align revenue cycle processes with value-based care initiatives.
Support reimbursement strategies related to Medicare Advantage, Medicaid, risk adjustment, HCC coding, quality incentive programs, STARS, HEDIS, and shared savings arrangements.
Monitor financial performance related to quality-based reimbursement opportunities.
Partner with operational teams to ensure documentation supports appropriate reimbursement and quality outcomes.
Develop and maintain revenue cycle dashboards and financial performance reports.
Analyze revenue trends, collections, payer performance, denial patterns, and operational metrics.
Present regular financial and operational updates to the CFO and executive leadership team.
Utilize data analytics to identify opportunities for process optimization and revenue enhancement.
Support organizational budgeting and forecasting activities related to revenue cycle operations.
Ensure compliance with CMS, Medicare, Medicaid, HIPAA, OIG, state regulatory agencies, and payer contractual requirements.
Maintain current knowledge of healthcare reimbursement regulations and industry best practices.
Support internal and external audits related to billing, coding, reimbursement, and revenue cycle operations.
Develop policies and procedures that support compliance and operational excellence.
Collaborate with Compliance and Quality leadership to address regulatory findings and implement corrective actions.
Directly supervise and mentor Revenue Cycle staff, fostering a culture of accountability, collaboration, and continuous improvement.
Establish performance expectations and conduct regular performance evaluations.
Identify training needs and develop educational programs to enhance staff competencies.
Promote employee engagement, retention, and professional development.
Ensure adequate staffing levels and workload distribution to meet departmental goals.
Evaluate and improve revenue cycle workflows to increase efficiency and effectiveness.
Partner with Information Technology and operational leaders to optimize system functionality and reporting capabilities.
Lead process improvement initiatives utilizing Lean, Six Sigma, and best-practice methodologies.
Identify automation opportunities that improve accuracy, productivity, and financial performance.
Support implementation of new technologies, billing systems, and process enhancements.
Collaborate with Finance, Clinical Operations, Quality, Compliance, Provider Relations, Credentialing, and Executive Leadership to achieve organizational objectives.
Serve as a trusted advisor to leadership regarding revenue cycle performance and reimbursement strategy.
Participate in organizational committees, strategic planning initiatives, and leadership meetings.
Foster strong working relationships with providers, health plans, vendors, and business partners.
Travel as necessary to support operational needs, provider engagement, and business initiatives.
Participate in special projects and organizational initiatives as assigned.
Other duties as assigned.