Director Managed Care & Payment Integrity

Job Description

Job Description

Responsibilities

Norman Regional Health System (NRHS) is seeking an experienced revenue cycle executive to serve as its Administrative Director of Revenue Cycle Management & Managed Care. This is a full-time, on-site leadership position responsible for the strategy, performance, and day-to-day operation of the organization’s end-to-end revenue cycle across Hospital Billing (HB), Professional Billing (PB), and

Ambulatory Services enterprises. This role will provide unified leadership over Revenue Optimization (Utilization Review & Charge Integrity), Patient Financial Services (Billing & Collections) and Managed Care (Payer Contracting & Relations). This role teams will organize teams around the revenue cycle continuum with clear ownership, accountability, and cross-department collaboration. The Administrative Director will drive net-revenue performance, accelerate cash collections, minimize avoidable write-offs, and maintain compliance, while building a data-driven, prevention-focused operating model.

The ideal candidate is a health-system revenue cycle leader with successful experience across front-end, middle, and back-end revenue functions, with strong financial and analytical acumen, and an executive presence to represent revenue cycle to the CFO, Executive Team, and Board.

Organizational Scope & Direct Reports

This position will report to the Chief Financial Officer

The Administrative Director leads multiple directors and their respective functions:

• Revenue Optimization: clinical documentation integrity (CDI), utilization review, charge integrity / charge description master (CDM), and revenue cycle analytics & KPI reporting.
• Patient Financial Services: billing and collections, cash posting, and associated customer service.
• Managed Care & Payment Integrity — payer contracting and negotiations, net-revenue reimbursement and payment integrity, denial root-cause analysis and prevention, payer escalation and relationship management, accounts receivable / underpayment recovery, and audit coordination.

Key Responsibilities

Enterprise Revenue Cycle Leadership & Strategy

• Provides a unified strategic and operational leadership for the end-to-end revenue cycle across Hospital Billing, Physician Billing, and Ambulatory Services Billing - building a single, continuum-based operating model.
• Establishes enterprise goals, budgets, and performance targets; owns overall revenue cycle results and reports performance to the CFO, Executive Team, and Board.
• Establishes and maintains clear ownership and accountability for every revenue cycle function, eliminating gaps and duplication of services across the NRHS locations and service lines.
• Drives net-revenue improvement and cash acceleration through management of A/R days, DNFB, discharged-not-final-coded (DNFC), and aged/high-dollar work-in-process (WIP) segmentation.
• Monitors and improves key revenue cycle KPIs using data-driven scorecards and dashboards to include cost-to-collect, clean-claim rate, denial rate, underpayment recovery, POS collections, bad debt and charity — using data-driven scorecards and dashboards.
• Partners with Finance on reserves, write-off governance, cost reporting, and month-end close as it relates to net revenue.
• Strengthens point-of-service collections and price-transparency / good-faith-estimate compliance.
• Ensures accurate, compliant, and timely coding, CDI, and utilization review; oversees charge integrity and CDM governance to protect expected reimbursement and reduce revenue leakage.
• Coordinates clinical denials prevention and government-audit response with clinical and denials leadership.
• Oversees billing/claims, cash posting, customer service, A/R and self-pay follow-up, and technical denials across all NRHS locations and service lines.
• Establishes productivity and quality standards, worklist discipline, and vendor performance expectations for back-end operations.
• Directs payer contracting and negotiation strategy, denial root-cause analysis and enterprise-wide denials prevention, payer escalation, and underpayment recovery.
• Provides oversight of payer relationship management, working closely with both internal and external partners.
• Manages revenue cycle vendors and platforms (e.g., EHR/billing systems, analytics, denial/underpayment, early-out and bad-debt partners); define scope, service levels, and measurable accountability, and evaluate build-vs-buy decisions.
• Recruits, develops, and retains a high-performing management team; establishes repeatable processes, SOPs, and governance for sustained performance.
• Fosters strong collaboration across clinical, financial, technological, and operational departments, including leading a regular cadence of revenue cycle governance and committee forums.
• Positions Revenue Cycle as a proactive organizational partner rather than a standalone function. Ensures consistent upstream communication and engagement so opportunities and concerns are identified and addressed before they become operational issues
• Ensures compliance with federal and state regulations, payer requirements, and organizational policy across all revenue cycle functions.

First-Year Priorities & Measures of Success

Within the first 12 months, the Administrative Director will strengthen current transformation gains, including:

• Maintaining HB DNFB at or below benchmark (≤ 6 days) and continue reducing total A/R days toward best-practice targets.
• Sustaining net-revenue and cash-acceleration performance against annual targets, with measurable reduction in avoidable write-offs and denials.
• Advancing managed-care contracting and payment-integrity capabilities in-house, reducing reliance on external vendors.
• Completing the phased integration of front, middle, and back-end functions under a single, governed operating model with clear ownership and SOPs.

Qualifications & Experience

Required:

• 10+ years of revenue cycle experience in a healthcare setting, including 5+ years at a director or higher level of leadership with oversight of multiple end-to-end functions across healthcare organizations with multiple service lines.
• Demonstrated results in net-revenue improvement, cash acceleration, denials reduction, and cost-to-collect performance in a hospital or health system setting.
• Experience leading and developing management teams with successful coordination and collaboration across internal and external stakeholder groups.
• Strong command of revenue cycle KPIs, analytics, and reporting, with a data-driven approach to decision making.
• Working knowledge across hospital, physician and ambulatory billing and reimbursement models, coding/CDI, charge integrity, billing, A/R, denials, and payer contracting concepts.
• Executive presence with the ability to synthesize complex information into clear recommendations for the CFO, Executive Team, and Board.
• Bachelor’s degree in Business, Healthcare Administration, Finance, or related field.

Preferred:

• Master’s degree (MBA / MHA) and relevant certifications (e.g., CRCR, CHFP, CPC/CCS, or comparable).
• Experience with Meditech and common revenue cycle / analytics platforms (e.g., FinThrive, VisiQuate, 3M).
• Experience in the Oklahoma / regional payer market and with multi-entity, multi-EHR (HB/PB/ASC) environments.

Position Structure

• This is a full-time, regular employment, on-site position based at Norman Regional Health System in Norman, Oklahoma.
• Reports directly to the Chief Financial Officer with strategic alignment and collaboration across the Executive Team.
• In the absence of the CFO, serves as the single accountable leader for enterprise-wide revenue cycle performance

Guiding Principles

• Organized around the revenue cycle continuum.
• Clear ownership and accountability.
• Strong collaboration across departments.
• Data-driven decision-making.
• Focus on prevention, accuracy, and recovery.

Work Environment & Physical Requirements

This is an on-site, office-based leadership role at Norman Regional Health System. The position may require occasional travel between NRHS facilities and extended or irregular hours during peak periods, month-end close, and key initiatives. Reasonable accommodations may be available to enable individuals with disabilities to perform the essential functions of the role.