Revenue Cycle Management Director

Job Description

Job Description:\n\nABOUT ADOBE \nAdobe Population Health (APH) is a women-owned health solutions company founded in 2018 with a mission of positively impacting the lives we touch. Headquartered in Phoenix, AZ, with satellite locations across multiple states, APH fosters a culture rooted in inclusivity, human kindness, and high-quality care. \nRecognized by Inc. 5000 as one of America’s Fastest-Growing Private Companies and honored for a fifth consecutive year as a “Best Place to Work” by the Phoenix Business Journal, APH continues to expand its reach and impact. \nAPH partners with health plans, providers, hospitals, and families to deliver tailored programs including case management, in-home and in-clinic wellness assessments, preventative care, transitional care, and social services. As one of the nation’s few fully integrated healthcare organizations, APH delivers comprehensive, coordinated medical and social support through a wide range of specialized service lines. \nWith continued growth on the horizon, APH is seeking mission-driven individuals who are passionate about improving health outcomes and supporting those in need. \n\nPOSITION PURPOSE \nThe Revenue Cycle Management Director provides strategic leadership for all aspects of Adobe Population Health's revenue cycle operations, including billing, coding, claims management, payment application, accounts receivable, denial management, reimbursement optimization, risk adjustment support, and revenue integrity. Reporting to the Chief Financial Officer, this role is responsible for maximizing reimbursement, strengthening cash flow, ensuring regulatory compliance, and building scalable revenue cycle processes that support the organization's continued growth. \nThe Director partners closely with Clinical Operations, Operations, Data Analytics, Quality, Compliance, Contracting, Customer Relationship Management, Information Technology, and Executive Leadership to optimize reimbursement across fee-for-service and value-based payment models. This role supports organizational initiatives related to Medicare Advantage, Medicaid, risk adjustment, HCC coding, quality incentive programs, STARS, HEDIS, and other population health reimbursement methodologies. \nThis position leads a high-performing Revenue Cycle team while leveraging data analytics, process improvement, and technology to drive operational excellence, revenue integrity, and exceptional customer service. The position is based in the Phoenix office (near SR-51, Glendale Avenue, and 16th Street) and requires working in the office five days per week. \n \nDUTIES & RESPONSIBILITIES \nRevenue Cycle Leadership & Strategy \n\n Provide strategic oversight and leadership for all revenue cycle functions, including patient eligibility verification, charge capture, coding review, claims management, payment posting, collections, denial management, and reimbursement optimization. \n Develop and execute the department's strategic plan, including annual goals, budgets, staffing, and operational roadmaps. \n Establish department objectives, performance standards, and key performance indicators (KPIs) that support operational excellence and financial performance. \n Collaborate with executive leadership to identify opportunities to enhance revenue integrity and maximize reimbursement. \n\nRevenue Cycle Operations \n\n Oversee all billing and claims submission activities to ensure timely, accurate, and compliant reimbursement. \n Monitor claims lifecycle performance, including clean claim rates, first-pass payment rates, days in accounts receivable, denial rates, payment posting timeliness, unapplied cash, and collection effectiveness. \n Ensure appropriate billing practices are followed for Medicare, Medicaid, commercial payers, and value-based care contracts. \n Oversee timely and accurate payment posting and cash application for all payer and patient receipts, ensuring payments are applied in accordance with contractual reimbursement methodologies. \n Monitor unapplied cash, payment variances, credit balances, and reconciliation processes to ensure the integrity of accounts receivable and financial reporting. \n Oversee accounts receivable management, including aging analysis, collection strategies, follow-up activities, and resolution of outstanding receivables to optimize cash flow and reduce bad debt. \n Develop processes to identify and resolve payment discrepancies, underpayments, overpayments, and unapplied cash in partnership with Finance and operational stakeholders. \n\nClaims Denials & Revenue Integrity \n\n Develop and oversee the organization's denial management program, including trend analysis, root cause identification, corrective action planning, and collaboration with operational teams to reduce revenue leakage. \n\nContract & Payer Management \n\n Provide operational reimbursement insights to support payer contract evaluation and negotiations. \n Monitor payer reimbursement performance and identify trends impacting financial performance and contract compliance. \n Partner with Customer Relationship Managers to investigate, resolve, and communicate reimbursement discrepancies, claims escalations, payment issues, and operational revenue cycle concerns with payer organizations. \n\nPopulation Health & Value-Based Care Support \n\n Collaborate with Quality, Clinical Operations, and Population Health leadership to align revenue cycle processes with value-based care initiatives. \n Support reimbursement strategies related to Medicare Advantage, Medicaid, risk adjustment, HCC coding, quality incentive programs, STARS, HEDIS, and shared savings arrangements. \n Monitor financial performance related to quality-based reimbursement opportunities. \n Partner with clinical, operations, and data teams to identify documentation gaps, coding opportunities, and workflow improvements that enhance reimbursement accuracy, reduce revenue leakage, and improve quality outcomes. \n\nPayment Posting & Cash Application \n\n Oversee timely and accurate payment posting and cash application for all cash receipts, ensuring payments are applied in accordance with contractual reimbursement methodologies and GAAP. \n Monitor unapplied cash, payment variances, credit balances, and reconciliation processes to ensure the integrity of accounts receivable and general ledger activity. \n Reconcile cash receipts, deposits, electronic remittance advice (ERA), electronic funds transfer (EFT), and bank activity related to revenue cycle operations. \n Develop processes to identify and resolve payment discrepancies, underpayments, overpayments, and unapplied or unidentified cash in a timely manner. \n Ensure payment posting workflows support accurate financial reporting, revenue recognition, and month-end close activities. \n\nFinancial Analysis & Reporting \n\n Develop dashboards and utilize analytics to monitor revenue cycle performance, reimbursement trends, payer performance, denials, and collection effectiveness. \n Present regular financial and operational updates to the CFO and executive leadership team. \n Utilize data analytics to identify opportunities for process optimization and revenue enhancement. \n Support organizational budgeting and forecasting activities related to revenue cycle operations. \n\nCompliance & Regulatory Oversight \n\n Ensure compliance with CMS, Medicare, Medicaid, HIPAA, OIG, state regulatory agencies, and payer contractual requirements. \n Maintain current knowledge of healthcare reimbursement regulations and ensure departmental policies and procedures remain compliant with applicable requirements. \n Support internal and external audits related to billing, coding, reimbursement, and revenue cycle operations. \n Collaborate with Compliance and Quality leadership to address regulatory findings and implement corrective actions. \n\nTeam Leadership & Staff Development \n\n Directly supervise and mentor Revenue Cycle staff, fostering a culture of accountability, collaboration, and continuous improvement. \n Establish performance expectations and conduct regular performance evaluations. \n Identify training needs and develop educational programs to enhance staff competencies. \n Promote employee engagement, retention, and professional development. \n Ensure adequate staffing levels and workload distribution to meet departmental goals. \n\nProcess Improvement & Technology Optimization \n\n Maintain current knowledge of healthcare reimbursement regulations and ensure departmental policies and procedures remain compliant with applicable requirements. \n Partner with Information Technology to optimize system functionality, reporting, and implementation of new revenue cycle technologies. \n Partner with Information Technology and operational leaders to optimize system functionality and reporting capabilities. \n\nOrganizational Collaboration \n\n Serve as a trusted advisor to executive leadership by collaborating across Finance, Clinical Operations, Quality, Compliance, Provider Relations, Contracting, Data Analytics, Information Technology, and Executive leadership to achieve organizational objectives. \n Build effective relationships with providers, health plans, vendors, and key business partners while representing the Revenue Cycle function on organizational committees and strategic initiatives. \n Participate in organizational committees, strategic planning initiatives, and leadership meetings. \n\nAdditional Responsibilities \n\n Travel as necessary to support operational needs, provider engagement, and business initiatives (less than 5%). \n Participate in special projects and organizational initiatives as assigned. \n Other duties as assigned. \n\n \nSKILLS & QUALIFICATIONS \n\n Seven (7) years of progressive healthcare revenue cycle experience. \n Three (3) years of leadership experience managing revenue cycle, billing, collections, or reimbursement teams. \n Strong understanding of healthcare reimbursement methodologies, including Medicare, Medicaid, Medicare Advantage, commercial insurance, and value-based care payment models. \n Experience supporting capitated, managed care, risk adjustment, or value-based reimbursement programs preferred. \n Knowledge of HCC coding, risk adjustment methodologies, STARS, HEDIS, and quality incentive reimbursement models preferred. \n Demonstrated success improving accounts receivable performance, collections, denial rates, and reimbursement outcomes. \n Demonstrated analytical, financial, project management, and problem-solving skills with the ability to use data to drive operational improvements. \n Excellent leadership, communication, and relationship-building skills with the ability to influence cross-functional teams and executive leadership. \n Experience managing vendor relationships and outsourced revenue cycle services preferred. \n Ability to thrive in a fast-paced, rapidly growing healthcare environment. \n Proficiency with healthcare revenue cycle platforms and financial systems, including Sage Intacct, Salesforce, Availity, Change Healthcare, and Microsoft Office Suite, or demonstrated ability to quickly learn comparable technologies. \n\n \nEDUCATION, LICENSES, & CERTIFICATIONS \n\n \n Bachelor’s degree in healthcare administration, business administration, finance, accounting, health information management, or a related field required.\n Master’s degree in healthcare administration (MHA), business administration (MBA), finance, or a related field preferred.\n Certified Revenue Cycle Executive (CRCE), Certified Healthcare Financial Professional (CHFP), Certified Professional Coder (CPC), Certified Professional Biller (CPB), or equivalent certification strongly preferred.\n Lean Six Sigma certification preferred.\n \n\n \nBENEFITS & TOTAL REWARDS\n\n \n Paid Orientation and Training \n Insurance – Medical, Dental, Vision, and Life\n 401k Plan – 3% match\n Employee Assistance Program\n Tuition Reimbursement\n Continued Education Support\n Mileage Reimbursement (if applicable)\n Referral Bonuses\n Paid Holidays (9 days)\n Flexible Time Off\n Paid Volunteer Hours \n \n\n \nCHARACTER & COMPETENCIES \n\n \n Courage – To have the courage to do the right thing at the right time.\n Ownership – To take ownership of every issue you touch.\n Respect – To respect yourself, co-workers, and for those whom you care.\n Excellence – To be excellent in all that you do.\n Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.\n Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethics; Upholds organizational values.\n Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.\n Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.\n Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.\n Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.\n Problem-Solving - Identifies and resolves problems promptly; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.\n Professionalism - Tactfully approaches others; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through with commitments.\n Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.\n \n\nPHYSICAL DEMANDS & WORK ENVIRONMENT\n\n Occasionally required to stand.\n Occasionally required to walk.\n Continually required to sit.\n Occasionally required to climb, balance, bend, stoop, kneel, or crawl.\n Continually required to talk or hear.\n While performing the duties of this job, the noise level in the work environment is usually moderate.\n Must be comfortable with working in a variety of conditions, including members’ homes, physicians’ offices, cold conditions, and hot conditions. \n The employee may occasionally lift and /or move more than 30 pounds.\n Must be able to physically perform the essential duties of the pos