DIRECTOR, FRONT-END REVENUE CYCLE MANAGEMENT

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.

About the Role

We are a private-equity backed surgical hospital and ASC platform operating 10+ facilities across Texas and Florida, with a service-line concentration in spine, orthopedics, ENT, and pain management. We are hiring a Director, Front-End Revenue Cycle Management to own facility-billing front-end operations to end-to-end-from scheduling intake through pre-bill audit gating.

This role exists to eliminate preventable denials, protect implant and device reimbursement, and stand up consistent front-end discipline across a fast-growing, multi-site platform. You will lead managers and supervisors across facilities, set the KPIs the platform is measured against, and act as the front-end counterpart to coding, billing, and contracting leadership.

POSITION’S ESSENTIAL RESPONSIBILITIES

Essential Duties/Responsibilities:

• Patient Access & Scheduling Accuracy
• Own pre-registration & accurate demographic capture across HST Pathways (ASCs) and CPSI/TruBridge (Surgical Hospitals); eliminate cross-facility identity mismatches that drive downstream denials.
• Standardize pre-service touchpoint cadence across all facilities so registration accuracy holds at or above 98% system-wide.
• Eligibility, Benefits Investigation & Prior Authorization
• Direct real-time eligibility and full benefits investigation workflows in Waystar/TruBridge RCM Clearinghouse platforms, including line-item benefits verification for high-cost implants and devices (spine hardware, total joint components, neurostimulators, etc. ) with documented remaining deductible, OOP max, implant carve-out language captured before the date of service.
• Establish and enforce a benefits verification completion threshold of 72 hours prior to the date of service for all scheduled cases, with same-day escalation protocols for late-scheduled or add-on procedures to ensure no case reaches the OR without confirmed coverage and auth on file.
• Enforce a platform-wide standard requiring active authorization on file for all scheduled cases no later than 72 hours prior to the date of service, with escalation triggers for any case approaching the threshold without confirmed auth and a hold protocol that prevents unverified cases from proceeding to the OR.
• Lead prior authorization for high-dollar procedures (lumbar/cervical fusions, total joings, Spinal Cord Stimulator trials and permanent implants, sinus and ENT implantable devices); maintain payer-specific authorization grids, LCD/NCD alignment, and a peer-to-peer escalation pathway with physicians.
• Track authorization approval rates, turnaround times, and peer-to-peer outcomes by payer and procedure category; use approval rate trends to identify payers tightening clinical criteria and proactively update auth submission templates and clinical packages before denial rates climb.
• Patient Financial Clearance & Price Transparency
• Own Good Faith Estimate production and pre-service delivery to all patients in compliance with No Surprises Act requirements, including convening-facility coordination and dispute resolution workflows.
• Optimize point-of-service collection standards (estimate generation, copay, deductible, and implant-share collection); target 90%+POS collection of patient responsibility on scheduled cases.
• Pre-Service Coding Review & Procedure Accuracy
• Lead pre-service coding reviews on high-revenue procedures to ensure the procedure, scheduled on the posting sheet is accurately reflected in the surgical packet- correct CPT/HCPCS codes, appropriate modifiers, and supporting documentation in place before the date of service.
• Partner with scheduling, surgeons' offices, and HIM/coding to resolve procedure mismatches, missing implant or device line items, and documentation gaps upstream of the OR, preventing the revenue loss and rework that results from miscoded or incomplete surgical packets reaching the billing team.
• Coding Intake & Documentation Readiness
• Build pre-bill audit gates that block claims missing op note completeness, implant invoice attachment, or required modifiers (PN for non-excepted off-campus HOPD services under Section 603 of the Bipartisan Budget Act of 2015; 50 bilateral; 59/XS for distinct procedural service; PT and others as applicable.)
• Partner with HIM/coding leadership to resolve documentation gaps before claim submission rather than as denials, and feed structural fixes back into surgeon office and pre-op workflows.
• Front-End Denial Prevention Analytics
• Build root-cause reporting on registration, eligibility, and authorization-driven denials by payer, facility, and service line.
• Hit and sustain platform front-end KPI targets: registration accuracy ≥ 98%, eligibility verified pre-service ≥95%, clean claim rate ≥98% first-pass authorization-driven denial rate < 2%, and eligibility-driven denial rate <1%.
• Set clear goals and expectations; provide regular coaching, feedback, and performance reviews.
• Develop talent through mentoring, training, and career development initiatives.
• Promote a collaborative and engaging work environment that aligns with company values.
• Manage conflict and make timely decisions to maintain team focus and performance.
• Conduct regular one-on-one meetings, performance reviews, and development conversations.
• Approve timecards, schedules, time-off requests, and other administrative HR functions.
• Ensure compliance with company policies, labor laws, and safety regulations.

EDUCATION AND EXPERIENCE REQUIREMENTS:

• Bachelor's degree in healthcare administration, finance, business, or related field- or equivalent combination of experience and credentials.
• 8+ years of progressive healthcare revenue cycle experience, with at least 4 years in a front-end leadership role (Manager or above).
• Preferred Qualifications
• Active credential in one or more of the following:
• HFMA: Certified Revenue Cycle Representative (CRCR) or Certified Healthcare Financial Professional (CHFP).
• NAHAM: Certified Healthcare Access Manager (CHAM) or Certified Healthcare Access Associate (CHAA)
• AAHAM: Certified Revenue Cycle Specialist (CRCS), Certified Revenue Cycle Professional (CRCP), or Certified Revenue Cycle Executive (CRCE).
• Prior experience at a private-equity backed multi-facility platform, including standing up centralized front-end functions and operating to EBITDA-linked KPIs.
• Experience integrating acquired facilities onto a common front-end platform (system conversions, CDM consolidation, payer grid harmonization.)
• Familiarity with implant-pass-through billing, NOPAIN Act non-opioid device payment rules, and carve out contract language for ortho, spine, and pain devices.
• Demonstrated experience leading front-end operations across multiple facilities or sites simultaneously.
• Knowledge of DRG optimization and high-cost outlier case management.
• Advanced Excel skills including pivot tables, formulas, and data analysis.
• Experience with clearinghouse systems and electronic claim processing.
• Familiarity with prior authorization platforms and payer portals.
• Service-line depth in at least two of: spine, orthopedics, ENT, pain management-including implant/device billing, authorization patterns, and LCD/NCD navigation.
• 3+ years of facility (UB-04) RCM experience-at Surgical hospitals or ASCs.

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.