Director of Revenue Cycle Management

Job Details: ADDISON, TX 75001 | Full Time | Day shift

Position Overview

OrthoMed Anesthesia is seeking a strategic, hands‑on Director of Revenue Cycle Management (RCM) to lead and optimize all aspects of anesthesia billing operations. This critical leadership role is responsible for the full RCM cycle, with a specialized focus on anesthesia‑specific complexities such as concurrency, medical direction, modifier usage, and payer compliance.

The Director will collaborate across departments—including clinical, IT, and executive leadership—to ensure financial accuracy, regulatory compliance, and operational efficiency across a growing network of providers and facilities.

Key Responsibilities

• Develop and implement RCM strategies to reduce days in A/R, improve cash flow, and minimize denials
• Oversee all components of the RCM process: billing, coding, charge posting, appeals, and patient financial services
• Monitor key performance indicators (KPIs) and produce actionable reports to inform decision‑making
• Direct accounts receivable inventory management strategies, including prioritization frameworks, aging bucket oversight, and productivity benchmarks to maximize collections velocity and minimize revenue leakage
• Oversee payer payment variance analysis, ensuring contractual underpayments are identified, documented, and recovered through systematic reconciliation of expected versus actual reimbursement across all payer contracts
• Lead comprehensive denial management and claims appeals programs, establishing root‑cause analysis workflows, appeal letter standards, and escalation paths to reduce denial rates and maximize overturn success
• Manage charge correction processes and systematic follow‑up on “No Activity” claims, ensuring timely resolution of suspended, rejected, or unworked accounts before filing deadlines are compromised
• Drive revenue assurance initiatives and maintain expert‑level knowledge of No Surprises Act (NSA) compliance, Independent Dispute Resolution (IDR) eligibility and jurisdictional requirements, and applicable state surprise billing regulations to protect net revenue
• Leverage technology solutions to enhance post‑bill efficiency, including agentic AI tools for intelligent A/R prioritization and workflow automation, and automated appeals platforms to accelerate denial resolution and reduce manual intervention
• Lead, mentor, and scale a team of onshore and offshore RCM personnel
• Collaborate with credentialing, compliance, and IT teams to optimize workflows and integrations
• Serve as the internal expert on anesthesia billing regulations and payer‑specific requirements
• Identify revenue trends and proactively address compliance risks
• Support internal audits, payer negotiations, and staff training initiatives
• Perform additional duties as needed in alignment with OrthoMed Anesthesia’s mission

Required Qualifications

• Bachelor’s degree in Healthcare Administration, Finance, or equivalent professional experience
• Minimum 5 years of progressive RCM leadership, with a strong background in physician‑based billing
• Deep understanding of CPT coding, ASA modifiers, concurrency rules, time documentation, and payer policies
• Knowledge of federal compliance standards, including CMS regulations
• Demonstrated experience designing and optimizing payment tracking and patient accounting workflows, including payment posting reconciliation, contractual adjustment controls, patient balance resolution, and financial clearance processes
• Working knowledge of or hands‑on experience with agentic AI solutions for post‑bill operations and automated appeals platforms, including AI‑driven A/R work queues, intelligent denial routing, and automated payer correspondence
• Demonstrated success in team leadership, change management, and driving performance improvements
• Strong communication and analytical skills; experience with business intelligence (BI) tools is a plus

Preferred Qualifications

• AAPC, HFMA, or CRCM certification
• Experience with anesthesia‑specific platforms (e.g., KAM, MedSuite, PPM, or PHI)
• Familiarity with Medicare, Medicaid, and major commercial payer billing guidelines
• Understanding of No Surprises Act (NSA), Independent Dispute Resolution (IDR), and Texas Department of Insurance (TDI) regulations
• Operational experience managing NSA/IDR submissions, including eligibility determinations, offer calculations, certified IDR entity coordination, and jurisdictional compliance across federal and state surprise billing frameworks
• Experience implementing or overseeing automated appeals management platforms and agentic AI tools integrated with anesthesia billing systems for denial resolution, payer correspondence, and post‑bill workflow orchestration

Benefits

At OrthoMed, we are committed to building a forward‑thinking anesthesia group rooted in transparency, compliance, and exceptional patient care. As part of our leadership team, you’ll receive:

• Competitive salary with performance‑based bonus opportunities
• Comprehensive health, dental, and vision insurance
• 401(k) plan with 3% non‑discretionary company contribution
• Paid holidays, PTO, and professional development support
• A collaborative and growth‑oriented work environment