Director of Revenue Integrity & Cycle Management

Job Description

Job Description

Key Responsibilities

Revenue Cycle Management

• Oversee the complete revenue cycle, including charge capture, claim submission, payment posting, collections, denials, appeals, and A/R management.
• Establish and monitor departmental KPIs for billers, collectors, posters, and other RCM staff.
• Monitor aging, collection rates, clean claim rates, denial rates, days in A/R, payment posting, and other key performance indicators.
• Ensure claims are submitted accurately and timely and that outstanding balances are appropriately worked.
• Develop strategies to reduce A/R, improve cash collections, and prevent avoidable denials.

Revenue Integrity & Compliance

• Ensure services are accurately documented, coded, charged, and billed in accordance with payer requirements and applicable regulations.
• Monitor charge capture and coding processes to identify missed charges, incorrect coding, underpayments, and potential revenue leakage.
• Partner with coding and clinical teams to address documentation and coding deficiencies.
• Maintain appropriate controls for contractual adjustments, write-offs, refunds, and account corrections.
• Conduct periodic audits to identify revenue integrity and compliance risks.

Denials & Reimbursement

• Oversee denial management and establish processes for timely follow-up, appeals, and root-cause analysis.
• Identify trends involving payer denials, authorization issues, coding errors, credentialing problems, and reimbursement discrepancies.
• Monitor payer reimbursement to identify underpayments and contract-related issues.
• Collaborate with Credentialing and Contracting to resolve payer enrollment and reimbursement issues.

Payment Posting & Reconciliation

• Ensure payments, adjustments, and patient collections are posted accurately and timely.
• Establish controls for unapplied payments, credit balances, refunds, and posting discrepancies.
• Partner with Finance to reconcile billing system activity to bank deposits and financial reporting.
• Ensure month-end revenue cycle reconciliation is completed accurately and within established deadlines.

Leadership & Performance Management

• Lead, develop, and hold accountable the billing and revenue cycle management team.
• Establish clear productivity and quality expectations for all RCM functions.
• Review staffing levels and recommend changes based on workload, productivity, and organizational needs.
• Develop standardized workflows, policies, procedures, and SOPs.
• Provide ongoing training and performance coaching.
• Hold regular operational meetings to review KPIs, barriers, outstanding A/R, denials, and collection performance.

Reporting & Analytics

• Develop and maintain daily, weekly, and monthly revenue cycle reporting.
• Provide leadership with accurate reporting on collections, A/R, denials, payment trends, and projected cash collections.
• Identify discrepancies between billing system reports, bank activity, and financial statements and ensure timely resolution.
• Present revenue cycle performance, risks, corrective actions, and improvement initiatives to executive leadership.

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, Finance, Accounting, or related field preferred.
• Minimum 5–7 years of healthcare revenue cycle experience, including management responsibility.
• Strong experience with physician billing and preferably ambulatory surgery center, anesthesia, pathology, infusion, or other ancillary billing.
• Strong understanding of Medicare, Medicaid, commercial insurance, managed care, and payer reimbursement.
• Knowledge of CPT, ICD-10, HCPCS, coding, charge capture, claims processing, denials, and reimbursement methodologies.
• Demonstrated experience managing A/R, collections, payment posting, denials, and revenue reconciliation.
• Strong analytical and financial reporting skills.
• Experience establishing KPIs, SOPs, internal controls, and performance-management processes.
• Experience with healthcare practice management and billing systems; eClinicalWorks experience is a plus.

Reporting Structure

Reports to: Executive Leadership

Direct Oversight: Billing, Collections, Payment Posting, Denials/Appeals, Revenue Integrity, and other Revenue Cycle functions as assigned.