Senior Director, Physician Revenue Cycle Management

Physician Revenue Cycle Management Position Overview

We are seeking an experienced and highly accomplished Senior Director of Physician Revenue Cycle Managementto provide executive leadership and operational oversight for the physician revenue cycle of a large, complex, multi-specialty medical practice.

This executive will have overall responsibility for the performance, strategy, and continuous improvement of the physician/professional billing revenue cycle, with accountability for ensuring accurate and timely reimbursement, optimizing cash collections, reducing accounts receivable and denials, improving operational efficiency, and delivering a high-performing revenue cycle operation.

The Vice President will oversee revenue cycle operations across a large physician enterprise and will work closely with executive leadership, physicians, practice leadership, finance, information technology, clinical operations, payers, and internal and external revenue cycle partners.

This position requires a leader who can operate effectively at both the strategic and operational levels—developing the long-term revenue cycle strategy while maintaining a detailed understanding of performance, identifying emerging issues, and ensuring that teams execute effectively.

Key ResponsibilitiesExecutive Leadership & Strategy

• Provide executive leadership and strategic direction for all aspects of physician/professional billing revenue cycle operations.
• Develop and execute a comprehensive revenue cycle strategy aligned with the organization’s financial, operational, and growth objectives.
• Establish performance expectations, operating standards, governance structures, and accountability across the revenue cycle organization.
• Serve as a senior revenue cycle advisor to executive leadership, physicians, and practice leaders.
• Evaluate current operations and develop strategies to improve financial performance, scalability, efficiency, quality, and service.
• Lead major revenue cycle transformation and performance-improvement initiatives.
• Anticipate changes in reimbursement, payer behavior, technology, regulation, and healthcare delivery and position the organization appropriately.

Revenue Cycle Performance

Maintain executive accountability for the performance of the physician revenue cycle, including:

• Charge capture and charge reconciliation
• Professional coding and coding-related workflows
• Claims preparation, editing, and submission
• Insurance accounts receivable
• Denials prevention and management
• Appeals and reconsiderations
• Underpayment identification and recovery
• Payment posting and reconciliation
• Credit balances and refunds
• Patient financial responsibility and self-pay processes
• Payer follow-up and escalation
• Revenue integrity
• Revenue cycle reporting and analytics

Establish, monitor, and continuously improve key performance indicators including:

• Gross and net A/R days
• A/R aging
• Cash collections
• Net collection rate
• Gross collection rate
• First-pass/clean claim rate
• Initial denial rate
• Final denial/write-off rate
• Charge lag
• Coding and billing productivity
• Payment posting timeliness
• Underpayments
• Cost to collect
• Accounts receivable inventory and work-queue performance

Identify material performance variances and ensure corrective action plans are developed, implemented, and monitored through resolution.

Denials & Revenue Integrity

• Develop an enterprise approach to denial prevention, management, and root-cause resolution.
• Ensure denials are appropriately categorized by payer, reason, specialty, provider, location, and responsible function.
• Partner with clinical and operational leadership to address upstream issues contributing to preventable denials.
• Oversee strategies for recovering underpayments and resolving systemic payer reimbursement issues.
• Identify revenue leakage and implement controls to improve charge capture and reimbursement.
• Ensure appropriate escalation of significant payer issues and reimbursement trends.

Operational Leadership

• Lead a large, complex physician revenue cycle organization supporting multiple specialties, locations, providers, and payer arrangements.
• Establish appropriate organizational structures, staffing models, management layers, workflows, and performance standards.
• Develop and mentor directors, managers, supervisors, and other revenue cycle leaders.
• Create a culture of accountability, measurable performance, continuous improvement, and service excellence.
• Ensure workloads and staffing are appropriately aligned with volumes and operational requirements.
• Develop scalable processes capable of supporting organizational growth and changes in the physician enterprise.
• Evaluate opportunities for automation, centralization, standardization, outsourcing, insourcing, and other operating-model improvements.

Physician & Practice Partnership

• Develop strong working relationships with physicians, practice executives, operational leaders, and clinical teams.
• Translate complex revenue cycle issues into clear financial and operational implications for senior leadership and physicians.
• Partner with practice leadership to address documentation, charge capture, coding, authorization, registration, and other issues affecting reimbursement.
• Establish clear accountability between revenue cycle and practice operations for issues that cross organizational boundaries.
• Provide transparent reporting regarding performance, risks, opportunities, and required actions.

Payer Management

• Identify significant payer performance issues, reimbursement trends, processing problems, and systemic denials.
• Develop escalation strategies for material payer issues.
• Collaborate with managed care, contracting, finance, legal, and operational leadership when payer intervention is required.
• Use revenue cycle data to identify contract-performance issues and opportunities to improve reimbursement.

Technology, Analytics & Automation

• Ensure effective utilization of EHR, practice management, clearinghouse, payer, analytics, and revenue cycle technology.
• Partner with information technology and operational teams to optimize revenue cycle system configuration and workflows.
• Champion automation and technology solutions that improve productivity, accuracy, scalability, and financial performance.
• Establish reliable executive reporting and analytics that provide visibility into revenue cycle performance and emerging risks.
• Ensure data is converted into actionable information for operational and executive decision-making.

Compliance & Controls

• Ensure physician revenue cycle operations comply with applicable federal and state requirements, payer policies, coding standards, contractual requirements, and organizational policies.
• Maintain appropriate controls related to billing, coding, reimbursement, patient information, and financial transactions.
• Partner with compliance, legal, audit, and finance teams as appropriate.
• Ensure appropriate protection of PHI and compliance with HIPAA and organizational information-security requirements.

Leadership Expectations

The role is expected to:

• Take ownership of revenue cycle results rather than simply report performance.
• Maintain a detailed understanding of the underlying drivers of financial and operational performance.
• Identify problems early and establish clear corrective actions.
• Use data and analytics to drive decisions and accountability.
• Build strong relationships across clinical, financial, operational, and executive teams.
• Develop strong leaders and create accountability throughout the organization.
• Balance immediate operational priorities with long-term strategic objectives.
• Effectively communicate complex issues to executives and physicians.
• Challenge existing processes when better approaches are available.
• Create measurable and sustainable improvements in revenue cycle performance.

QualificationsRequired

• Significant progressive leadership experience in healthcare revenue cycle management with substantial responsibility for physician/professional billing .
• Demonstrated experience leading revenue cycle operations for a large physician group, health system, academic medical center, management services organization, or similarly complex healthcare organization.
• Deep understanding of physician billing, reimbursement, insurance A/R, denials, coding, payer processes, and revenue cycle operations.
• Demonstrated experience managing large teams and developing revenue cycle leaders.
• Strong knowledge of revenue cycle KPIs and the ability to translate operational data into financial and strategic action.
• Demonstrated success improving revenue cycle financial and operational performance.
• Strong executive communication, leadership, analytical, and problem-solving capabilities.
• Ability to work effectively with physicians, executives, finance leaders, operational leadership, payers, and other senior stakeholders.

Preferred

• Bachelor’s degree in business, healthcare administration, finance, accounting, or a related field; advanced degree preferred.
• Experience leading revenue cycle operations within a large multi-specialty physician enterprise.
• Experience with Epic professional billing and related revenue cycle applications.
• Experience overseeing both internal and outsourced revenue cycle operations.
• Experience with significant revenue cycle transformations, system implementations, integrations, or organizational growth.
• Relevant HFMA, AAPC, AHIMA, or other healthcare revenue cycle credentials.

Success Measures

Success in this position will be measured by the ability to:

• Optimize cash collections and reimbursement.
• Reduce A/R days and aged accounts receivable.
• Reduce preventable denials and write-offs.
• Improve clean claim and first-pass payment performance.
• Reduce revenue leakage and underpayments.
• Improve productivity and cost to collect.
• Establish clear accountability across revenue cycle and practice operations.
• Build a high-performing revenue cycle leadership team.
• Provide accurate, actionable, and transparent performance reporting.
• Deliver sustainable improvements in the financial performance of the physician enterprise.

Benefits:

• Retirement Plan
• Retirement Plan matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person