Director of Revenue Cycle

Job Description

Job Description

Position Summary

The Director of Revenue Cycle serves as the senior operational and strategic leader responsible for the financial performance of the professional revenue cycle across Children’s Hospital Los Angeles Medical Group. This role provides leadership and oversight for revenue cycle operations, including charge capture, coding, billing, accounts receivable management, denial prevention, payment posting, revenue integrity, reimbursement optimization, patient account services, vendor performance, and transformation initiatives.

Under the direction of the Chief Financial Officer and in close partnership with executive leadership, physician leaders, operational stakeholders, and external revenue cycle partners, the Director drives sustainable improvements in cash collections, net revenue realization, compliance, operational effectiveness, and overall revenue cycle performance.

The Director is accountable for developing and executing a comprehensive revenue cycle strategy that supports organizational growth, financial stewardship, operational excellence, regulatory compliance, and physician practice sustainability. Through strategic leadership, cross-functional collaboration, and performance-driven execution, this role is responsible for delivering measurable improvements in revenue cycle outcomes and advancing the organization’s long-term financial objectives.

Key Responsibilities

Strategic Revenue Cycle Leadership

• Develop and execute the organization’s professional revenue cycle strategy in alignment with enterprise financial and operational goals.

• Serve as a strategic adviser to executive leadership regarding revenue cycle performance, reimbursement trends, regulatory changes, operational risks, and improvement opportunities.

• Establish and execute a multi-year revenue cycle transformation roadmap designed to improve operational effectiveness, financial performance, technology utilization, stakeholder satisfaction, and organizational scalability.

• Lead initiatives to improve financial performance, operational effectiveness, revenue capture, reimbursement, and physician satisfaction.

• Identify opportunities to enhance net revenue realization while maintaining compliance and operational integrity.

• Support organizational growth initiatives, new service development, acquisitions, and practice expansion efforts through revenue cycle planning and operational readiness.

Revenue Cycle Operations and Practice Partnership

• Provide leadership and oversight for professional revenue cycle functions, including:

o Charge capture and reconciliation

o Professional coding operations

o Claim editing and submission

o Payment posting

o Accounts receivable management

o Denial prevention and appeals

o Credit balance management

o Revenue integrity activities

o Reimbursement optimization

o Patient account resolution and customer service

o Vendor management and performance oversight

• Serve as the primary liaison between clinical divisions, practice operations leadership, and revenue cycle operations to ensure alignment across the revenue cycle continuum.

• While this role does not directly oversee clinic-based patient access, scheduling, registration, authorization, or front-end practice operations, it is responsible for partnering with practice operations and division leadership to address upstream issues that impact billing accuracy, reimbursement, denial performance, charge capture, and overall revenue cycle outcomes.

• Partner with division administrators, practice managers, physician leaders, and operational leadership to identify and resolve operational barriers that negatively affect financial performance.

• Provide revenue cycle subject matter expertise to support provider onboarding, new clinic implementation, program expansion, operational redesign, and new service activation.

• Partner with provider enrollment, credentialing, managed care, practice operations, and division leadership to support revenue cycle readiness for new providers, locations, services, and programs.

Cross-Functional Revenue Cycle Governance

• Establish governance structures, operating committees, and performance review processes that support enterprise-wide accountability for revenue cycle outcomes.

• Create strong partnerships with practice operations, clinical divisions, finance, human resources, compliance, information technology, managed care, and external revenue cycle partners.

• Lead cross-functional efforts to address root causes of denials, reimbursement delays, charge capture deficiencies, authorization issues, workflow breakdowns, and operational inefficiencies occurring upstream of billing.

• Establish escalation pathways and decision-making forums to address unresolved revenue cycle barriers, clarify accountabilities, and ensure timely issue resolution.

• Influence operational improvements through collaboration, governance, stakeholder engagement, and data-driven recommendations rather than direct reporting authority over clinic operations.

• Facilitate organizational alignment around revenue cycle priorities, initiatives, performance expectations, and strategic objectives.

Financial Performance Accountability

• Accountable for achieving performance targets related to:

o Cash collections

o Net collection rate

o First-pass claim acceptance rate

o Days in accounts receivable

o AR aging performance

o Denial rates

o Write-off reduction

o Charge lag

o Coding accuracy

o Revenue capture

o Underpayment recovery

• Monitor trends, identify root causes of performance gaps, and implement corrective action plans.

• Develop and execute action plans to improve cash performance, reduce accounts receivable, minimize denials, optimize reimbursement, and strengthen overall revenue cycle performance.

• Develop financial forecasts, performance projections, and operational improvement plans to support executive decision-making.

• Identify payer-specific reimbursement trends, denial patterns, underpayment issues, and operational barriers. Partner with finance, managed care, and executive leadership to support reimbursement optimization and payer escalation efforts when appropriate.

Revenue Integrity, Coding, and Compliance

• Oversee revenue integrity programs to ensure services are consistently, accurately, and compliantly billed.

• Collaborate with compliance, finance, and physician leadership to mitigate revenue leakage and reimbursement risk.

• Support provider education efforts related to documentation quality, coding accuracy, charge capture, and payer requirements.

• Monitor regulatory requirements and payer policy changes affecting reimbursement.

• Ensure compliance with federal, state, payer, HIPAA, and organizational requirements.

• Lead audits, corrective action plans, and remediation efforts as necessary.

Vendor and Technology Governance

• Provide executive oversight of revenue cycle vendors and business partners.

• Establish service-level agreements, performance expectations, accountability measures, and reporting requirements.

• Monitor vendor performance against established KPIs and contractual obligations.

• Lead governance meetings, escalation management activities, and strategic planning efforts with external partners.

• Oversee performance of outsourced and co-managed revenue cycle service delivery models, ensuring accountability for agreed-upon service levels, financial outcomes, operational performance, and continuous improvement initiatives.

• Partner with information technology and operational leaders to optimize revenue cycle technology platforms and workflows.

• Drive implementation and adoption of automation, reporting, analytics, and workflow optimization tools.

Physician, Division, and Operational Partnership

• Partner with physician leaders, division chiefs, department administrators, and operational leaders to improve financial performance and revenue realization.

• Communicate revenue cycle performance, risks, opportunities, and operational priorities to stakeholders across the organization.

• Provide divisional revenue cycle performance reviews and actionable insights to support informed decision-making.

• Collaborate with leadership to address specialty-specific reimbursement, coding, documentation, and operational challenges.

• Serve as a trusted adviser to physician and operational leadership regarding revenue cycle trends, performance, and best practices.

Data Analytics and Performance Management

• Develop and maintain enterprise revenue cycle scorecards, dashboards, and executive reporting packages.

• Establish meaningful KPIs and operational metrics that drive accountability across the organization.

• Utilize data analytics to identify trends, root causes, operational risks, and improvement opportunities.

• Benchmark performance against industry standards and organizational goals.

• Present revenue cycle performance, strategic initiatives, operational risks, and improvement recommendations to executive leadership, physician leadership, and organizational governance committees.

Leadership and Talent Development

• Provide leadership and direction to revenue cycle managers and staff.

• Foster a culture of accountability, collaboration, innovation, service excellence, and continuous improvement.

• Recruit, develop, mentor, and retain high-performing revenue cycle professionals.

• Establish performance expectations, succession planning strategies, and professional development opportunities.

• Promote employee engagement and organizational effectiveness.

Minimum Qualifications

• Bachelor’s degree in healthcare administration, business administration, finance, Accounting, or related field.

• Eight (8) years of progressively responsible healthcare revenue cycle leadership experience.

• Five (5) years of experience leading managers and multi-functional teams.

• Demonstrated experience managing professional billing and collections operations within a multi-specialty physician practice, academic medical group, or integrated delivery system.

• Demonstrated experience leading revenue cycle improvement initiatives resulting in measurable financial outcomes.

• Strong knowledge of managed care reimbursement methodologies, payer operations, denials management, coding, compliance, and physician revenue cycle workflows.

• Demonstrated expertise using data analytics to drive operational and financial performance improvements.

• Experience working within highly matrixed organizations and influencing stakeholders without direct reporting authority.

Preferred Qualifications

• Master’s degree in business administration, Healthcare Administration, public health, Public Administration, finance, or related field from an accredited graduate program of a reputable university.

• Academic faculty practice experience.

• Pediatric healthcare experience.

• Experience overseeing outsourced or co-managed revenue cycle service delivery models.

• Professional certification, such as HFMA, CMPE, FACMPE, CRCR, CPC from MGMA/ACMPE, or equivalent.

• Experience leading large-scale revenue cycle transformation initiatives.

Core Competencies

• Strategic Thinking

• Executive Presence

• Financial Acumen

• Revenue Cycle Expertise

• Change Leadership

• Relationship Management

• Matrix Leadership

• Operational Excellence

• Data-Driven Decision-Making

• Team Leadership and Development

• Process Improvement

• Physician Engagement

• Vendor Governance

• Accountability and Results Orientation

Pediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles.

Company Description

Pediatric Management Group manages 600+ physician academic practice affiliated with Children's Hospital Los Angeles.