Director of Revenue Cycle Management

Description

Job Summary:

The Director of Revenue Cycle provides strategic leadership and operational oversight of William Newton Hospital’s (WNH) entire revenue cycle function, including patient access, billing, coding, claims, denials management, accounts receivable, and payer relations. This position is responsible for achieving revenue goals established through WNH’s organizational planning and goal-setting processes, as approved by the CFO. The Director develops and implements strategies to maximize third-party revenue, improve collections, reduce denials, and ensure compliance across all payer types, including Medicaid, Medicare, commercial insurance, and VA, etc. The Director reports to the Chief Financial Officer. This position builds and leads a sustainable team structure with sufficient cross-training and depth to ensure continuity of operations.

Standards of Behavior

William Newton Hospital’s Standards of Behavior allow a mechanism for holding each employee accountable and encourages us to "raise the bar".All employees are expected to familiarize themselves with the Standards and practice them daily.

• i - Integrity

We act with unwavering moral principle,

transparency, and sincerity in every

interaction.

• P - Patient-Centered

We meet patients where they are, ensuring

the are active participants in their care

journey. We prioritize the patient's physical

and emotional well-being over all else.

• A - Accountability

We own our actions. We set clear

expectations and hold all team members to

the same high standards.

• C - Compassion

We treat every patient, family member, and

colleague with kindness, empathy, and

dignity.

• E - Excellence

We approach every task, large or small, with

enthusiasm. We continually pursue mastery

and best practices in our field.

Job Duties & Responsibilities

Strategic Revenue Growth & Operations

• Develop and execute revenue cycle strategies aligned with organizational revenue goals approved by the CFO, working collaboratively with the executive leadership to achieve financial targets.
• Monitor payer mix trends, identify shifts impacting revenue, and implement corrective strategies to protect and grow high-value reimbursement streams, including ensuring patients are enrolled in available coverage programs.
• Develop revenue models, billing workflows, and staffing plans for new and expanding service lines prior to launch, ensuring billable services are operationally supported before patient volume scales.
• Oversee end-to-end revenue cycle performance across all billing platforms and service lines, ensuring timely claim submission, accurate coding, and maximum reimbursement.
• Recommend and propose revenue cycle investments, technology enhancements, and staffing adjustments to the CFO and CEO for approval, including budget justification aligned with projected revenue impact.

Denial Management & Accounts Receivable

• Provide strategic oversight of the denial management function, including review of trending data, root cause analysis, and systemic interventions to reduce denial rates and improve recovery.
• Establish and enforce AR aging thresholds, write-off policies, and escalation protocols; develop and maintain KPI policy frameworks defining targets if such policies do not yet exist.
• Monitor net collection rates, days in AR, clean claim rate, and other key performance indicators by payer and service line; present performance reports and variance analysis to the CFO and executive leadership.

Patient Access & Front-End Revenue Integrity

• Provide oversight and standards for patient access functions, including registration accuracy, insurance verification, eligibility confirmation, prior authorization, and point-of-service collections.
• Ensure consistent patient access standards across all service lines and locations, working collaboratively with clinical program leadership to align front-end processes with billing requirements.
• Oversee patient financial counseling and coverage enrollment assistance, collaborating cross-departmentally to ensure eligible patients are connected with available insurance programs, tribal sponsorship, or financial assistance.

Coding & Charge Capture

• Oversee coding operations to ensure accuracy, compliance, and timeliness across all service lines and coding systems (CPT, ICD-10-CM, CDT, HCPCS).
• Establish coding quality assurance processes, including periodic audits, provider education, and feedback loops to improve documentation and reduce coding-related denials.
• Monitor charge capture workflows and chart closure timelines; partner with clinical leadership and health information management to reduce DNFB and coding lag.

Payer Relations & Contract Management

• Serve as WNH’s subject matter authority on payer requirements, reimbursement methodologies, and contract terms; prepare analysis and recommendations for payer contract negotiations, with final authority resting with the CEO/CFO.
• Monitor fee schedule updates, regulatory changes, and payer policy shifts affecting reimbursement; communicate impacts to the revenue cycle team and executive leadership.
• Monitor provider enrollment status across all active payers in coordination with credentialing staff; enforce enrollment service level agreements and advance delays impacting billing readiness.

Systems & Technology

• Oversee revenue cycle operations across all billing and practice management platforms used by the organization, ensuring workflow efficiency, data integrity, and system interoperability.
• Collaborate with IT, clinical leadership, and external partners on the evaluation, selection, design, implementation, and ongoing optimization of electronic health record (EHR) and billing systems.
• Document and upgrade system issues affecting revenue cycle operations; represent WNH’s revenue cycle requirements in technology governance and partnership forums.
• Serve as a WNH representative on applicable WNH advisory committees related to health information systems and technology partnerships.

Staff Leadership & Development

• Recruit, develop, and retain a high-performing revenue cycle team; directly supervise specialized staff and ensure adequate staffing levels across all functions.
• Build team capacity through cross-training, process documentation, and succession planning to ensure the function operates sustainably.
• Foster a culture of continuous improvement, accountability, and professional development within the team.
• Conduct performance evaluations, provide coaching and mentorship, and address performance issues in accordance with WNH policies and procedures.

Compliance, Reporting & Cultural Sensitivity

• Ensure all revenue cycle operations comply with applicable federal, state, and tribal regulations, including HIPAA, CMS guidelines, IHS, and applicable confidentiality requirements for specialized programs.
• Partner with the Quality Director on compliance program activities related to billing, coding, and documentation; the Director does not hold primary compliance program authority.
• Prepare and present revenue cycle reports to the CFO, executive leadership as requested, including performance metrics, trend analysis, and strategic recommendations.
• Uphold and promote cultural sensitivity in all revenue cycle interactions, ensuring that financial processes respect the unique needs, values, and cultural practices of WNH.
• Other related duties as assigned.

Requirements

Minimum Qualifications (Education & Experience)

• Bachelor’s degree in healthcare administration, business administration, health information management, finance, or a related field.
• Five (5) years of progressively responsible experience in healthcare revenue cycle operations, including demonstrated experience in revenue growth initiatives such as denial reduction, payer strategy, coding optimization, or new service line billing.
• Two (2) years of supervisory experience managing teams or functional areas, or demonstrated equivalent leadership responsibility.
• A combination of relevant experience, education, and training may substitute for education and experience requirements on a year-for-year basis.

Preferred Qualifications (Education & Experience)

• Master’s degree in healthcare administration (MHA), business administration (MBA), or related field.
• Ten (10) or more years of healthcare revenue cycle experience with progressive leadership responsibility.
• Experience operating across multiple billing and EHR platforms simultaneously.
• Professional certification such as CPC, CPB, CRCR, CHFP (Certified Healthcare Financial Professional), or equivalent.
• Experience in RHC's preferred and a strong commitment to multi-disciplinary teamwork.

Necessary Knowledge, Skills, and Abilities

• Knowledge of healthcare revenue cycle processes from patient registration through collections, including charge capture, coding, claim submission, payment posting, denial management, and AR follow-up.
• Knowledge of multi-payer billing requirements including Medicaid, Medicare, commercial insurance, and VA.
• Knowledge of medical terminology, CPT, ICD-10-CM, CDT, and HCPCS coding systems sufficient to oversee coding operations and evaluate quality.
• Knowledge of HIPAA privacy and security requirements as applied to revenue cycle operations.
• Effective oral and written communication skills.
• Skills in operating personal computers using a variety of computer software, including healthcare billing platforms, electronic health records, and data analytics tools.
• Skill in strategic planning, financial analysis, and translating revenue data into actionable improvement plans.
• Skill in leading and developing teams, including supervising supervisory staff and managing contracted or remote resources.
• Ability to influence change and build collaborative relationships across departments and with external partners without direct authority, using data, credibility, and partnership.
• Ability to establish and maintain cooperative working relationships with management, coworkers, and outside contacts.
• Ability to maintain strict confidentiality and comply with all applicable federal laws and WNH policy (HIPAA, etc.).
• Ability to learn and apply program/agency operating policies and procedures.
• Ability to manage multiple priorities and tasks concurrently and meet deadlines.
• Ability to work independently as well as with teams.

Job Duties and Responsibilities:

• Demonstrates the ability to direct and coordinate the patient accounting function in order to consistently produce accurate bills which are paid in a timely manner.
• Monitors activities continually with collection agencies, insurance companies, Admissions, Medical Records, Information Systems, patients and physicians; coordinates operation and recommend corrective action, as appropriate.
• Effectively utilizes and understands the departmental computer system in order to realize its optimal potential and to be able to evaluate staff member questions regarding the mechanics of the system.
• Demonstrates tact and diplomacy when setting patient accounts and responding to physicians’ requests to discount patient bills; follows established facility guidelines.
• Works effectively with auditors in locating various patient bills as required; demonstrates cooperation and responsiveness.
• Maintains a current awareness of third-party reimbursement regulations and contractual arrangements with HMOs and PPOs.
• Promotes good staffing practices by maximizing the utilization of human resources; forecasts and anticipates the personnel needs of the Department with regard to fluctuations in the projected workload; holds staffing at a functional minimum; effectively employ part-time help.
• Organizes the Department in a manner that consistently responsible to patient/customer needs.
• Consistently demonstrates good organizational skills in the routine accumulation of statistical information and reports it to the Chief Financial Officer (CFO) in an accurate and timely manner.
• Effectively coordinates the Patient Accounts function with Accounts Receivable, Registration, HIM and Nursing departments on a routine basis.
• Effectively maintains all required records for the Department; demonstrates good organizational skills.
• Continually works toward establishing an environment within the department which reduces the “paper shuffle” through increased use of computer technology and more effective methods of activity consolidation.
• Demonstrates the ability to devise more efficient methods and systems for getting the work done in the Department; reduces the use of time and effort to an effective minimum; institutes change in techniques and procedures as necessary.
• Strive to achieve Organizational and Department goals.
• Round on staff and send thank you notes monthly.

Working Conditions

The physical demands described here are representative of those that an employee must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions. While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is frequently required to stand and/or sit. The employee is occasionally required to walk, sit, climb, or balance. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, peripheral vision, and depth perception. The noise level in the work environment is usually average. Occasional participation in meetings outside standard office hours required.