Director of Revenue Cycle

We are seeking a Director of Revenue Cycle to add to our dynamic team. The Director of Revenue Cycle Operations leads the daily operations and ongoing transformation of billing accounts receivable payment posting cash reconciliation credit balance and related revenue cycle functions across a complex multi-state behavioral healthcare organization. Reporting to the Vice President of Revenue Cycle the Director is accountable for timely and accurate claim submission effective payer follow-up accurate payment and adjustment posting disciplined account resolution and measurable improvement in cash aging quality and productivity.

This is a hands-on operational leadership role. The Director must understand the detailed mechanics of claims work queues clearinghouse transactions payer edits remittances denials adjustments unapplied cash refunds and account documentation. The leader will personally analyze workflows and representative accounts when needed establish standardized processes and desk-level procedures design an effective organizational structure identify system limitations and configuration opportunities and evaluate responsible uses of automation and artificial intelligence. The role partners with Centralized Admissions Department Patient Financial Services Utilization Review Clinical Operations Finance Information Technology Compliance and external vendors while maintaining clear ownership of back-end revenue cycle execution.

Responsibilities

• Provide direct operational leadership for billing accounts receivable follow-up payment posting cash reconciliation credit balances refunds and related back-end revenue cycle functions
• Maintain detailed knowledge of daily inventory work queues claim status billing holds clearinghouse rejections payer responses payment exceptions aged accounts and unresolved operational barriers
• Conduct detailed reviews of workflows and representative patient accounts to determine what occurred what should have occurred and what corrective action is required
• Design and standardize end-to-end workflows from charge release and claim creation through payment follow-up adjustment refund and final account resolution
• Establish clear ownership handoffs service-level expectations escalation pathways and quality controls for every major billing accounts receivable and payment-posting workflow
• Oversee claim generation claim-edit resolution clearinghouse submission payer acceptance rejection correction and timely filing controls
• Develop payer-specific accounts receivable strategies using age balance payer denial reason filing limit reimbursement risk and probability of collection to prioritize work
• Establish standards for follow-up frequency account documentation next-action dates escalation appeal write-off review and final disposition
• Oversee accurate ERA and manual payment posting contractual and non-contractual adjustments denial posting recoupments takebacks unapplied cash deposits refunds and daily and monthly reconciliation
• Create controls that ensure posted cash and adjustments reconcile to bank deposits remittance files general ledger activity and expected payer reimbursement
• Develop and maintain standard operating procedures desk-level instructions workflow maps training materials audit tools and change-control processes
• Establish daily weekly and monthly productivity quality timeliness and inventory standards by function and role
• Build dashboards and operating reviews that translate revenue cycle data into clear actions owners deadlines and measurable outcomes
• Design the billing accounts receivable and payment operations organizational structure based on actual workload transaction volumes skill requirements span of control and future growth
• Assess staffing needs role clarity management layers workload distribution cross-training coverage plans and opportunities to consolidate or specialize work
• Develop leaders and front-line team members through clear expectations coaching training quality feedback performance management and succession planning
• Identify process failures system limitations configuration issues interface gaps duplicate work and manual workarounds that create delay error or unnecessary cost
• Partner with Information Technology system vendors and operational stakeholders to define requirements test changes validate outcomes and sustain improvements
• Evaluate automation and artificial intelligence opportunities using clear business cases expected return workflow impact data quality privacy compliance and human oversight requirements
• Prioritize process correction and standardization before automating unstable or poorly controlled workflows
• Lead backlog reduction system remediation payer-specific improvement initiatives and other focused recovery efforts while protecting current production
• Partner with Patient Access and Utilization Review leaders to resolve upstream issues affecting claim quality or reimbursement without assuming operational ownership of those functions
• Collaborate with Finance on cash reporting month-end close reserves write-offs refunds reconciliation and financial reporting accuracy
• Maintain compliance with HIPAA 42 CFR Part 2 payer contracts governmental requirements internal controls and organizational policies
• Perform other duties assigned in support of Revenue Cycle and organizational objectives.

Qualifications

• Bachelors degree in healthcare administration business finance accounting health information management or a related field or an equivalent combination of education and directly relevant leadership experience
• Minimum 10 years of progressive healthcare revenue cycle experience including at least 5 years leading billing accounts receivable payment posting or closely related back-end revenue cycle operations
• Demonstrated expert-level knowledge of the day-to-day mechanics of claim generation and submission claim edits and rejections payer follow-up denial resolution remittance processing contractual adjustments cash reconciliation credit balances refunds and final account resolution
• Demonstrated experience personally reviewing claims work queues remittances account notes system transactions and workflow exceptions to identify root causes and verify operational performance
• Demonstrated experience building centralizing restructuring or materially improving healthcare billing accounts receivable or payment operations
• Experience developing standard operating procedures desk-level workflows role definitions productivity expectations quality audits performance dashboards and escalation pathways
• Experience designing staffing models and organizational structures using inventory transaction volumes payer mix complexity service-level expectations and productivity assumptions
• Experience identifying system limitations configuration gaps manual workarounds and opportunities for workflow automation
• Strong analytical ability with experience using revenue cycle data to diagnose operational problems and drive corrective action
• Proven ability to lead managers and front-line teams through change while maintaining daily production quality accountability and staff engagement
• Working knowledge of HIPAA 42 CFR Part 2 payer requirements and applicable federal and state billing and collection requirements

Preferred Qualifications

• Masters degree in healthcare administration business administration finance or a related field
• Behavioral health and substance use disorder revenue cycle experience including residential inpatient partial hospitalization intensive outpatient and outpatient services
• Experience within a multi-site and multi-state healthcare organization with centralized revenue cycle operations
• Experience with commercial insurance Medicare Medicaid Managed Medicaid TRICARE Veterans Affairs and other government or managed-care payers
• Experience optimizing an electronic health record practice management system clearinghouse payer portal banking platform or revenue cycle work queue solution
• Experience evaluating or implementing automation robotic process automation machine learning or artificial intelligence solutions within revenue cycle operations
• Experience with system conversions mergers acquisitions integrations or rapid organizational growth
• Professional certification such as CHFP CRCR HFMA certification or an equivalent revenue cycle credential

Were officially a Great Place to Work ! Weve always believed that supporting our team is just as important as supporting our patients. Now were proud to share that weve earned Great Place to Work Certification - based entirely on feedback from our own employees. Read more here: Bradford Health Services we are committed to providing exceptional care to our patients while fostering a supportive and rewarding workplace for our employees. We believe that taking care of our team allows them to take better care of others which is why we offer a comprehensive benefits package designed to support their well-being.

• Medical Coverage Three new BCBSAL medical plans with better rates improved co-pays and enhanced prescription benefits.

• Expanded Coverage Options for domestic partners and a wider network of in-network providers.

• Mental Health Support Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching.

• Voluntary Coverages Pet insurance home and auto insurance family legal services and more.

• Student Loan Repayment Available for nurses and therapists.

• Retirement Benefits 401(k) plan through Voya to help employees plan for the future.

• Generous PTO A robust paid time off policy to support work-life balance.

• Voluntary Benefits for Part-Time Employees Dental vision life accident insurance and telehealth options for those working 20 hours or more per week.

#INDHP

Required Experience:

Director