DIRECTOR OF REVENUE CYCLE

Job Description

Job Description

About Legent Health

At Legent Health , our mission is simple yet profound: “To provide first-class health care that puts YOU first.”

Our vision reflects our commitment to excellence: “Through robust physician partnerships, become a nationwide leader in compassionate, quality healthcare focused on the patient and available to everyone.”

Our values, also known as our brand pillars, define how we stay true to our identity in the healthcare industry and the communities we serve. These values are central to everything we do:

• Respect: We honor the time and trust of both patients and physicians by delivering organized, efficient services that ensure a seamless healthcare experience.
• Service: We are committed to highly personalized care for patients, their families, and the physicians who serve them, driving optimal outcomes for all.
• Leadership: We strive to be a trusted leader through innovation, clear communication, and unwavering dedication to excellence across our employees and partners.

Joining Legent Health means being part of a team that lives these principles every day, as we build a future focused on compassionate, quality care.

This position has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications which may be required of the employee assigned to the position. Depending on the size of the facility the job duties may vary. Receipt of the job description does not imply nor create a promise of employment, nor an employment contract of any kind; my employment with the Company is at-will.

Our Company Mission is "To provide first class health care that puts YOU first." and our Company Vision is "Through robust physician partnerships become a nationwide leader in compassionate, quality healthcare focused on the patient and available to everyone."

Job Summary:

The Director of Revenue Cycle Management is a hands-on operational leader within Legent Health’s Managed Services Organization (MSO), providing direct oversight of coding operations and accounts receivable functions across a multi-facility platform of surgical hospitals and ambulatory surgery centers (ASCs). This role is integral to driving coding accuracy, AR performance, denial resolution, and workflow standardization across 11+ facilities specializing in spine, orthopedic, ENT, and pain management.

This role is approximately 80% operational and 20% strategic, requiring a leader who has done the work—someone who understands the nuance of surgical coding, knows how to move AR, and can hold a team accountable to measurable results. The Director reports directly to the AVP of Revenue Cycle Management and serves as a critical bridge between frontline RCM staff and senior leadership.

Essential Duties/Responsibilities:

Coding Operations

• Provide direct oversight of inpatient and outpatient coding teams, ensuring accuracy and timeliness across ICD-10-CM/PCS, CPT, and HCPCS coding for surgical specialties including spine, orthopedics, ENT, and pain management.
• Drive MS-DRG optimization through appropriate principal diagnosis selection, complication/comorbidity (CC/MCC) capture, and procedure coding accuracy for surgical inpatient encounters.
• Monitor and maintain coding quality metrics including coding accuracy rates, coder productivity benchmarks, charge lag, and unbilled A/R related to coding holds.
• Conduct or coordinate regular audits of coded charts, identify patterns of error or missed revenue opportunity, and implement coder education and corrective action plans.
• Oversee charge capture integrity across CPSI/TruBridge and HST Pathways environments, ensuring CDM alignment and appropriate charge reconciliation post-encounter.
• Collaborate with clinical operations and compliance teams to ensure coding reflects documented clinical intent and meets payer and regulatory requirements.

Accounts Receivable Management

• Lead AR specialist teams across payer categories including commercial, Medicare, Medicaid, workers’ compensation, and managed care, maintaining accountability for aging buckets, follow-up timelines, and collection performance.
• Establish and enforce AR work queue structures and prioritization protocols to ensure timely payer follow-up and appropriate escalation of aged or high-dollar claims.
• Monitor AR aging reports and collection trends at the facility and payer level; identify root causes of AR aging and implement corrective workflows to reduce days in A/R.
• Partner with billing and payment posting teams to ensure clean claim submission, timely ERA/EOB application, and accurate account resolution across Waystar and facility PM systems.

Denial Management

• Own the denial management function end-to-end—from root cause identification using CARC/RARC data to appeal submission, payer escalation, and process correction.
• Build and maintain denial reporting frameworks that categorize denials by type, payer, facility, and root cause, enabling targeted operational improvement.
• Work directly alongside coders and AR specialists to resolve complex denial scenarios including medical necessity, authorization, coding-based, and timely filing denials.
• Identify systemic denial trends and develop or update SOPs to prevent recurrence at the point of access, coding, or billing.

Project Management

• Lead and manage RCM-specific projects from initiation through completion, including system implementations, facility onboardings, payer enrollment initiatives, and workflow redesign efforts across the MSO’s surgical platform.
• Develop and maintain project plans with clearly defined milestones, owners, timelines, and success metrics; communicate status updates and risk flags to the AVP on a regular cadence.
• Manage transitions of RCM functions — including new facility integrations, vendor changes, and in-house migrations — with minimal disruption to billing continuity and cash flow.
• Identify operational dependencies and sequencing risks across concurrent projects; proactively escalate conflicts or resource constraints before they impact go-live timelines.
• Build and maintain project documentation including SOPs, workflow diagrams, training materials, and post-implementation review summaries to support knowledge retention and staff onboarding.
• Support change management efforts by communicating process changes clearly to coding and AR teams, ensuring adoption is tracked and issues are resolved quickly.

Process Optimization & Performance Management

• Develop, document, and enforce standard operating procedures for coding workflows, AR follow-up, and denial resolution tailored to outpatient surgical environments.
• Define and track KPIs including clean claim rate, first-pass resolution rate, denial rate by payer/type, coder accuracy, AR days, and cash collection performance.
• Identify workflow inefficiencies and drive continuous improvement initiatives that reduce rework, improve throughput, and protect net revenue.
• Provide regular performance reporting and operational updates to the AVP highlighting trends, risk areas, and action plans with measurable outcomes.

Team Leadership & Cross-Functional Collaboration

• Directly supervise and develop coding and AR team leads and specialists, building a culture of accountability, transparency, and continuous improvement.
• Conduct regular 1:1s, team huddles, and performance reviews; address performance gaps proactively with clear expectations and documented action plans.
• Collaborate with the AVP on automation initiatives, technology optimization (CPSI/TruBridge, HST Pathways, Waystar), and integration of new facilities into the MSO operating model.
• Serve as an operational subject matter expert supporting cross-functional projects with IT, compliance, finance, and clinical leadership.
• Ensure adherence to payer guidelines, federal and state regulations, and contractual billing requirements across all facilities and service lines.

Required Skills/Abilities:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field required; relevant certifications (CPC, CCS, RHIT, or equivalent) strongly preferred.
• Minimum of 7 years of progressive experience in healthcare revenue cycle operations, with at least 3 years in a supervisory or management role overseeing coding and/or AR teams.
• Demonstrated hands-on experience managing both IP/OP coding staff and AR specialist teams—candidates with only high-level supervisory experience will not be considered.
• Strong working knowledge of ICD-10-CM/PCS, CPT, HCPCS, and MS-DRG assignment, with specific experience in surgical specialties (spine, orthopedics, ENT, or pain management preferred).
• Deep understanding of the claims lifecycle, payer adjudication logic, CARC/RARC denial classification, and AR resolution workflows.
• Proficiency in EHR/PM systems used in surgical environments, including CPSI/TruBridge and/or HST Pathways; experience with Waystar or comparable clearinghouse platforms required.
• Data-driven mindset with experience building or utilizing RCM reporting dashboards and KPI frameworks to manage team performance and drive accountability.
• Skilled at identifying process gaps and translating findings into actionable SOPs and training materials for frontline staff.
• Exceptional organizational skills with the ability to manage competing priorities across multiple facilities and functional areas simultaneously.
• Strong interpersonal and communication skills with the ability to engage effectively with frontline staff, peer leaders, and senior stakeholders.

Physical Requirements:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, stand, talk, and hear. The employee is frequently required to use hands and fingers to handle or operate standard office equipment, and to reach with hands and arms. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required include close vision and the ability to adjust focus.

Why Join Legent Health?

Legent Health fosters an environment where team members are empowered to deliver exceptional care while growing professionally within a supportive, values-driven culture.

We Offer:

• Competitive salary and performance incentives
• Comprehensive benefits package
• Paid time off and wellness programs
• Career development and training opportunities

Equal Employment Opportunity (EEO) Statement

Legent Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, disability status, or any other legally protected characteristic.

I-9 and E-Verify Compliance:
Employment eligibility will be verified through the U.S. Department of Homeland Security’s E-Verify system. All applicants must provide valid documentation to establish identity and authorization to work in the United States, as required by federal law.