Senior Director, Revenue Cycle

Reporting to the Chief Operating Officer, the Senior Director, Revenue Cycle serves as a key executive leader responsible for optimizing financial performance, strengthening payor relationships, and advancing the organization’s strategic position within an increasingly complex healthcare reimbursement landscape. This individual will cultivate a strong, collaborative partnership with the organization’s outsourced Revenue Cycle Management (RCM) provider, which delivers comprehensive end-to-end revenue cycle services, while directly overseeing internal payor contracting, payor relations, credentialing, and payor intelligence functions. The Sr. Director will champion operational excellence through continuous process improvement, data-driven decision-making, strategic use of technology, and operational alignment with clinical and administrative leaders. Provide strategic leadership and oversight for all phases of the revenue cycle—spanning patient access, scheduling, financial clearance, registration, billing, charge capture and reconciliation, coding, denials management, collections, health information management (HIM), utilization review, revenue integrity, and account resolution. Establish operational frameworks, service-level agreements (SLAs), performance dashboards, and governance structures to ensure alignment, accountability, and consistency across decentralized sites and service lines. Develop and enforce enterprise-wide policies, procedures, and standards for revenue cycle operations, ensuring full compliance with Medicare, Medicaid, commercial payor contracting terms, federal/state laws, accreditation standards, and managed care requirements. Collaborate with the outsourced RCM vendor to standardize workflows, optimize staffing models, measure vendor performance, and ensure that the vendor is fully integrated with the enterprise mission, metrics, and culture. Lead revenue integrity initiatives, including charge description master (CDM) management, coding accuracy, documentation improvement, auditing, claim reconciliation, and denial prevention/recovery. Drive continuous process improvement initiatives—utilizing LEAN, Six Sigma, or equivalent methodologies—to reduce cost-to-collect, minimize rework, accelerate days in accounts receivable (A/R), reduce denial rates, and improve cash flow. Ensure seamless integration of revenue cycle operations with clinical workflows, EHR/EMR systems, patient financial services, revenue analytics, and enterprise growth strategies (e.g., acquisitions, new service lines). Oversee budget development and management for the revenue cycle function, monitoring expense variances, resource deployment, ROI of automation initiatives, and vendor cost-effectiveness. Payor Relations & Strategy Design and execute a comprehensive payor engagement strategy covering commercial payors, government payors, self-pay/cash-based models, and specialty service payors (e.g., aesthetics, plastics, cosmetic services). Lead market analysis and review for all cash-based service lines—such as aesthetics, plastic surgery, cosmetic dermatology, wellness services—to evaluate pricing models, reimbursement opportunities, patient financing structures, and profit margin potential. Foster and maintain high-impact relationships with payor organizations, provider networks, physician hospital organizations (PHOs), and key strategic partners to enhance patient access, reimbursement negotiation, issue resolution, and long-term alignment. Monitor and interpret payer policy changes, industry formulation (e.g., value-based reimbursement, alternative payment models), regulatory updates, and competitor contract trends; translate these insights into operational strategies and contract positioning. Coordinate with clinical leadership and operational teams to align service line growth strategies, access initiatives, and reimbursement opportunities to the broader organizational mission and business objectives. Lead negotiation, renewal, and management of all third-party payor agreements—commercial, government, fee-for-service, bundled payments, capitation, and value-based arrangements. Develop modeling tools, scenario analytics, and margin-based evaluations to guide contracting decisions, assess market competitiveness, and prioritize growth opportunities. Introduce innovative contracting frameworks (e.g., gain-sharing, shared savings, bundled pricing, hybrid models) that align provider incentives, improve patient access, and support clinical value while maintaining financial sustainability. Ensure contract terms and reimbursement arrangements align with enterprise strategy, service line expansion, and provider compensation structures. Establish and monitor contract performance metrics (e.g., payment lag, underpayment, denial rate by payer, audit outcomes) and ensure corrective actions are taken where performance dips or payer issues emerge. Credentialing Oversee provider enrollment and payor credentialing operations—ensuring timely orientation of providers into payor networks, accurate contract coding and classification, primary source verification, and credentialing lifecycle management. Standardize credentialing workflows and cycle-time metrics—introducing automation, workflow tracking, and digital toolsets to increase throughput, transparency, and error‑free provider access into payor panels. Integrate credentialing operations with scheduling, provider onboarding, contracting, physician services, and revenue cycle workflows to prevent delays, service gaps, and revenue leakage. Leadership & Governance Provide leadership and oversight of the outsourced RCM vendor relationship, holding the vendor accountable for agreed performance metrics, continuous improvement, operational transparency, scalability, and adherence to enterprise standards. Lead internal teams in Payor Relations and Credentialing, fostering high‑performance culture, staff development, collaboration, metrics‑driven operations, and cross‑functional alignment. Chair the following governance bodies: Revenue Cycle Committee , Payor Intelligence & Analytics Committee , and Revenue Optimization Committee —ensuring committee charters, agendas, action tracking, and executive escalation processes are tightly managed. Work across departments—Internal Audit, Compliance, Legal, Information Technology, Operations, Clinical Leadership—to ensure full integration of revenue cycle strategies, risk mitigation, regulatory compliance, and operational alignment. Serve as a senior executive representing revenue cycle interests to the board, CEO, CFO, and other senior leadership—communicating strategy, performance, risks, and opportunities with clarity and authority. Strategic Planning & External Alignment Partner with the CFO, COO, CEO and senior leadership team to develop and implement long‑term strategies that support enterprise growth, service line expansion, payor alignment, revenue diversification, and margin improvement. Lead strategic initiatives related to geographic expansion, acquisition integration, service line launches, and operational redesign—ensuring that revenue cycle and payor contracting considerations are embedded early in the planning process. Maintain strong external relationships with industry associations, consultant networks, analytics providers, and peer groups to stay ahead of market trends, benchmarking data, regulatory changes, and emerging technologies. Evaluate, recommend and oversee implementation of emerging technologies, new reimbursement models, and market‑disruptive service lines—ensuring the organization sustains competitive advantage and operational readiness. Performance Monitoring & Optimization Develop and maintain robust dashboards, KPIs, scorecards and reporting frameworks that provide full transparency into revenue cycle performance, payer contract metrics, denials, collections, A/R aging, cost-to-collect, clean claim rate, net payment per case, and cash flow. Continuously analyze performance metrics, identify root causes of underperformance, and lead cross‑functional interventions that drive measurable improvement. Ensure timely resolution of operational issues by partnering with operational teams, IT, the RCM vendor, and analytics teams—facilitating action plans, monitoring execution, and validating impact. Lead a culture of continuous improvement by introducing process redesign, performance benchmarking, automation, and technology‑enabled solutions to improve operational efficiency, reduce cost, increase velocity of cash flow, and optimize margin. Ensure that key initiatives deliver sustainable results and align with enterprise objectives—measuring ROI, tracking benefit realization, and embedding continuous governance. #J-18808-Ljbffr