Director, Revenue Cycle
Full-time
Upward Health
Role Description
The Director, Revenue Cycle is the enterprise owner of end-to-end revenue cycle performance across Upward Health’s operations. This role is accountable for the accuracy, efficiency, and scalability of all revenue cycle functions—including:
- Charge capture
- Coding
- Billing
- Claims submission
- Denial management
- Collections
This position operates as a hands-on leader, combining operational oversight with data-driven performance management in a complex, multi-system environment. The Director is responsible for:
- Optimizing workflows across Athenahealth and third-party platforms
- Leveraging analytics, automation, and emerging AI tools to enhance outcomes and reduce administrative burden
- Partnering closely with finance, operations, clinical, and IT leadership to ensure alignment with organizational goals and evolving payer requirements
- Leading teams across billing, coding, and accounts receivable functions
- Establishing a culture of accountability, continuous improvement, and data-driven decision-making
Qualifications
- 7–10+ years of progressive experience in revenue cycle management
- Direct, hands-on experience with Athenahealth
- Advanced Excel skills, including data modeling and reporting automation
- Strong analytical mindset with high attention to detail
- Proven track record improving revenue cycle KPIs and operational efficiency
- Experience implementing process improvements and workflow automation
- Demonstrated ability to quickly learn and adapt to new systems
- Experience leading teams within a healthcare billing or revenue cycle environment
Requirements
- Experience in value-based care or risk-based contracting environments (preferred)
- Familiarity with EDI transactions (835/837) and clearinghouse operations (preferred)
- Experience leveraging AI or automation tools in healthcare operations (preferred)
- Bachelor’s degree in Healthcare Administration, Finance, or related field (Master’s preferred)
Key Responsibilities
- Revenue Cycle Operations:
- Oversee all aspects of the revenue cycle, including intake, eligibility verification, coding, charge entry, claims submission, AR follow-up, denial management, and payment posting
- Establish and monitor KPIs such as days in AR, denial rate, first-pass resolution rate, and net collection rate
- Identify root causes of revenue leakage and implement corrective actions
- Ensure timely, accurate claims submission and reimbursement across all payer types
- Athenahealth Optimization:
- Serve as the internal subject matter expert for Athenahealth practice management and billing workflows
- Configure and optimize system rules, edits, and reporting to maximize efficiency and clean claim rates
- Partner with IT and operations on enhancements, automations, and integrations
- Troubleshoot system issues and drive continuous improvement in platform utilization
- Data Analytics & Reporting:
- Leverage advanced Excel capabilities (pivot tables, XLOOKUP, Power Query) to analyze large datasets
- Build and maintain dashboards and reporting tools for leadership
- Translate complex data into clear insights and operational improvements
- Ensure data integrity across systems and reporting outputs
- Process Improvement & Automation:
- Design, document, and standardize SOPs across the revenue cycle
- Identify and implement workflow improvements to reduce manual intervention
- Drive scalable process enhancements that support organizational growth
- Establish measurable performance metrics and accountability standards
- AI & Workflow Innovation:
- Identify and implement AI-enabled tools to optimize revenue cycle processes (e.g., denial prediction, coding support, automation)
- Evaluate emerging technologies and vendors for efficiency and accuracy improvements
- Lead pilots and deployments of automation solutions that reduce administrative burden
- Develop a forward-looking roadmap for AI integration across revenue cycle functions
- Compliance & Risk Management:
- Ensure compliance with payer requirements, CMS guidelines, and regulatory standards (including HIPAA)
- Monitor audit outcomes and implement corrective actions
- Maintain accurate documentation and coding integrity
- Leadership & Team Development:
- Lead and develop teams across billing, coding, and AR functions
- Establish performance expectations and provide ongoing coaching
- Foster a culture of accountability, continuous improvement, and operational excellence
- Partner cross-functionally with clinical, operational, and finance leaders
Key Competencies
- Detail-oriented and highly organized
- Data-driven decision-making
- Strong systems thinking and process design capabilities
- Technologically forward, with a focus on AI and automation
- Effective communicator with ability to translate data into action
- Results-driven with strong accountability and execution focus
Vacancy posted 2 hours ago
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