Director of Revenue & Reimbursement

Revenue Cycle Director

Under the immediate supervision of the CFO, is responsible for leading and supporting all back-end revenue cycle operations, including billing, coding, cash posting, charge capture, denial resolution, accounts receivable, and revenue integrity.

This role ensures accurate and compliant revenue generation through oversight of billing and coding functions with support from the Decision Support group, reimbursement optimization and supporting organizational charge capture. The CFO maintains accountability for pricing strategy and payer contracting, while the Director of Revenue is responsible for operational execution, system integrity, and performance of approved financial structures.

Responsibilities:

1. Revenue Cycle Leadership (Back-End Operations)

• Lead all post-service revenue cycle functions, including billing, coding, charge capture, claims submission, cash posting, and accounts receivable

• Drive performance across key financial and operational KPIs, including clean claim rate, days in A/R, denial rate, and net collection rate

• Ensure alignment between clinical documentation, coding, billing processes, and payer requirements

2. Billing & Accounts Receivable Management

• Oversee timely and accurate claims submission and follow-up with Outsourced team

• Manage A/R performance, including segmentation (early-out and mature A/R workflows) with the support of third party managers

• Ensure timely resolution of underpayments, denials, and aging accounts

• Optimize cash flow through improved billing cycle efficiency • Key KPI: Days in A/R, Clean Claim Rate, Early-Out Collection Rate

3. Coding Operations & Compliance

• Oversee ICD-10, CPT, HCPCS coding accuracy and compliance with third party group

• Support coding audits and corrective action plans as provided by coding education team and from third party vendors.

• Ensure alignment between documentation, coding, and reimbursement rules

• Maintain coding productivity and accuracy standards for inpatient and surgical coding.

• Key KPI: Coding Accuracy Rate (%)

4. Revenue Integrity & Denials Management

• Lead denial management strategy, including resolution and root cause analysis as supported by Decision Support team.

• Partner with Patient Access to address upstream drivers of denials (eligibility, authorization, scheduling, registration)

• Implement corrective actions to reduce repeat denials and improve first-pass yield

• Identify and address revenue leakage across the revenue cycle

• Key KPI: Initial Denial Rate, Denial Overturn Rate

5. Cash Posting & Payment Integrity

• Oversee accurate and timely posting of payments, adjustments, and contractual allowances

• Ensure reconciliation of cash receipts and payer remittances

• Maintain accuracy in financial reporting and A/R integrity

• Key KPI: Posting Lag (Days), Reconciliation Accuracy (%)

6. Price Estimation (Shared Accountability with Patient Access)

• Ensure accuracy of estimation logic, CDM mapping, and contract assumptions

• Partner with Patient Access to deliver accurate, consistent patient-facing price estimates

• Support system configuration and methodology behind estimation tools

• Key KPI: Estimate Accuracy (Variance %), Estimate Utilization Rate (%)

7. Bad Debt & Financial Assistance Oversight

• Manage bad debt workflow, including vendor oversight and write-off processes

• Ensure appropriate classification of accounts into charity care, financial assistance, or bad debt

• Monitor trends and identify upstream prevention opportunities

• Key KPI: Bad Debt as % of Net Revenue

8. Financial Reporting & Revenue Cycle Analytics

• Own revenue cycle reporting, dashboards, and performance analytics

• Ensure accuracy, timeliness, and consistency of financial reporting

• Partner with CFO on net revenue performance analysis and forecasting

• Work with Decision Support team to support accurate reporting

• Key KPI: Reporting Timeliness & Accuracy (%)

9. Leadership & Team Development

• Oversight of In-house billers, coders and cash posters.

• Establish clear performance expectations, accountability structures, and development plans

• Foster cross-functional collaboration with Patient Access and Finance

• Drive a culture of operational excellence and continuous improvement

Leadership Capabilities

· Budget management: prepares department budget

· Decisiveness: displays an appropriate bias for action, mindful problem definition and calculated risks, determines when data is sufficient for decision-making and moves forward, seeks "win-win" outcomes

· Leading others: has a plan and clear expectations. Involves and delegates appropriately. Holds associates accountable and confronts problem behavior or unsatisfactory performance promptly and fairly. Assures that recognition and rewards are linked to quality actions

· Managing relationships: maintains constructive "key stakeholder" relationships; confronts issues without alienating others; uses collegial approach, and positive personal influence to achieve cooperation

· Operational plan: demonstrates knowledge and skills necessary to develop and implement operational plan

· Results-oriented: demonstrates perseverance and focus in the face of obstacles; takes responsibility and moves forward; is timely and comprehensive in follow-through and achievement

· Style flexibility: can be both firm and compassionate; can lead and let others lead; is self-confident, but demonstrates appropriate humility; aware of personal impact and effectively adapts to different circumstances

· Completes all annual evaluations on or before the due date

Organizational Expectations:

· Attendance: Attendance is an essential job function; employee comes to work daily, on time, and completes scheduled shift

· HIPAA: facilitates to maintain patient confidentiality

· Internal communication: contributes to positive team performance and a culture of service excellence through effective communication, active listening, and respect

· Interpersonal relationships: maintains appropriate interpersonal relationships with staff, patients, and visitors at all times. Works as a team member with other departments.

· Safety: Practices workplace safety daily

Employee Engagement:

· Actively participates in all hospital Service Excellence initiatives and trainings

· Attends and participates in a minimum of 50% department staff meetings and signs off on review of 100% department staff meeting minutes

· Completes all required annual education on or before the due date

Knowledge Skills and Abilities: Individuals must possess these knowledge, skills, and abilities or be able to explain and demonstrate that they can perform the primary functions of the job, with or without a reasonable accommodation, using some combination of skills and abilities and possess the necessary physical requirements, with or without a reasonable accommodation, to safely perform the essential functions of the job.

· Minimal physical effort required with occasional light lifting to a maximum of 25 pounds; stooping; and pick, pinch, type, or otherwise work primarily with fingers

· Ability to effectively manage considerable mental stress

· Ability to express or exchange ideas by means of the spoken word

· Ability to receive detailed information through oral communication

· Ability to communicate effectively with co-workers and convey information in a clear, concise and accurate manner

· Familiarity with computer and other business machines

Qualifications:

A Bachelor's degree in Business, Finance, Accounting, Information Management, Healthcare Information, Computing, Mathematics, Statistics, or related field preferred.

Experience: At least seven years of clinical health experience, previous analyst experience, in-depth knowledge of HCPCS, ICD-9/ICD-10, and understanding of regulatory issues. Working knowledge of financial statements and ability to analyze financial information. Solid understanding of the information systems used in the billing and collection process. Ability to integrate the financial, clinical, and coding processes to improve compliance and maximize reimbursement

Certification in billing and coding represented by any of the following RHIA, RHIT, RN, CPC, CPC-H, CCS or CCS-P

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