Health Business Solutions LLC

Job Title: Revenue Cycle Operations Director

Job Summary:

The Revenue Cycle Operations Director will oversee all aspects of the revenue cycle, from billing and coding to claims processing and collections. This role will be responsible for ensuring the efficiency, accuracy, and financial integrity of revenue cycle processes, driving improvement initiatives, and ensuring compliance with industry regulations. The Director will collaborate with key departments such as business intelligence, sales, and operations to optimize revenue cycle functions and align with the overall company strategy.

Key Responsibilities:

• Leadership and Strategy:

  • Lead, manage, and mentor the revenue cycle management team, ensuring a high level of engagement and productivity.
  • Develop and implement strategies to improve revenue cycle processes, reduce denials, and enhance revenue capture.
  • Analyze revenue cycle trends, including key performance indicators (KPIs), to develop improvement strategies that align with company goals.

Revenue Cycle Management:

• Oversee all functions of the revenue cycle, including patient registration, coding, billing, claims processing, payment posting, denial management, and collections.
• Collaborate with departments such as operations, business intelligence, and sales to improve workflows and achieve revenue optimization.
• Develop and maintain policies and procedures related to revenue cycle activities, ensuring compliance with healthcare regulations and payer requirements.
• Ensure timely and accurate submission of claims and the effective management of accounts receivable to maintain optimal cash flow.

Team Collaboration:

• Work closely with the operations and business intelligence teams to create streamlined workflows and reduce operational inefficiencies.
• Coordinate with the sales and growth department to identify new opportunities and ensure revenue cycle readiness for expanded service lines or contracts.

Process Improvement and Optimization:

• Identify and implement revenue cycle improvements, using data-driven analysis to reduce claim denials, shorten revenue cycle time, and enhance payment collections.
• Introduce automation or technological solutions where possible to improve efficiency in revenue cycle processes.
• Monitor regulatory changes that impact revenue cycle operations and ensure compliance with federal, state, and payer guidelines.

Financial Oversight:

• Work closely with finance and executive leadership to create revenue cycle financial reports and contribute to strategic planning.
• Manage and monitor the departmental budget, making adjustments as necessary to optimize resource allocation and performance.

Compliance and Reporting:

• Ensure adherence to all federal, state, and local laws and regulations related to billing, coding, and collections.
• Prepare and present regular reports on revenue cycle performance, including KPIs, for executive leadership.
• Conduct audits to ensure the accuracy and integrity of revenue cycle operations.

Qualifications:

• Bachelor’s degree in Business Administration, Healthcare Management, Finance, or a related field (Master’s preferred).
• 7+ years of experience in revenue cycle management, with at least 3 years in a leadership role.
• Strong understanding of healthcare billing and coding, payer regulations, and revenue cycle processes.
• Proven experience in developing and implementing process improvements.
• Excellent analytical, problem-solving, and decision-making skills.
• Ability to work collaboratively with cross-functional teams and executive leadership.
• Strong organizational and leadership abilities, with experience managing large teams.
• Excellent communication and presentation skills.

Preferred Skills:

• Familiarity with revenue cycle management software and tools (e.g., Epic, Cerner, Athenahealth).
• Knowledge of healthcare revenue cycle KPIs and best practices for improving metrics like Days in Accounts Receivable (AR), denial rates, and collections.