The Director of Revenue Cycle Management is responsible for overseeing all aspects of the revenue cycle, from patient registration and insurance verification through final payment collection. This leadership role ensures optimal reimbursement, regulatory compliance, and financial performance across all service lines and the ASC. The Director will lead and develop the billing team while implementing best practices to maximize revenue and minimize denials.
Essential Functions- Oversee end-to-end revenue cycle functions including patient access, charge capture, coding, billing, collections, and payment posting
- Manage revenue cycle operations for both the medical practice and ambulatory surgery center
- Monitor and analyze key performance indicators (KPIs) including days in A/R, denial rates, clean claim rates, and collection percentages
- Develop and implement policies and procedures to optimize revenue capture and reduce claim denials
- Ensure accurate and timely claim submission across all payer types (commercial, Medicare, Medicaid, workers' comp)
Multi-Specialty Billing Oversight- Maintain expertise in specialty-specific billing requirements for ENT, Allergy, Audiology, Facial Plastics, and Full Body Plastics procedures
- Oversee ASC facility billing and ensure proper coordination with professional fee billing
- Ensure compliance with coding guidelines (CPT, ICD-10, HCPCS) specific to each specialty
- Manage prior authorization processes, particularly for surgical procedures and implantable devices (hearing aids, cochlear implants, cosmetic vs. reconstructive determinations).
Team Leadership & Development - Lead, mentor, and develop the billing team
- Establish performance standards, conduct regular evaluations, and provide ongoing training
- Foster a culture of accountability, continuous improvement, and excellent customer service
- Coordinate with Clinical Managers, Surgical Coordinators, and Practice Administrator
Compliance & Regulatory - Ensure compliance with federal and state healthcare regulations, HIPAA, and payer requirements
- Stay current on regulatory changes affecting reimbursement (CMS updates, payer policy changes)
- Conduct regular audits to ensure coding accuracy and billing compliance
- Manage payer contract analysis and assist with contract negotiations
Financial Reporting & Analysis - Prepare and present regular reports on revenue cycle performance to leadership and physician owners
- Identify trends, variances, and opportunities for revenue enhancement
- Develop and manage departmental budget
- Collaborate with Practice Administrator on financial planning and forecasting
Education and/or experience Required: - Bachelor's degree in healthcare administration, Business, Finance, or related field
- Minimum 7-10 years of progressive experience in healthcare revenue cycle management
- At least 3-5 years in a leadership/management role
- Experience with multi-specialty physician practice billing
- Experience with ASC/facility billing strongly preferred
- Proficiency with practice management systems and EHR platforms
- Strong knowledge of CPT, ICD-10, and HCPCS coding systems
- Thorough understanding of payer contracts, reimbursement methodologies, and healthcare regulations
Preferred: - Master's degree in healthcare administration, MBA, or related field
- Professional certification: CPMA, CPC, CRCE-I, or similar
Skills & Competencies - Strong analytical and problem-solving abilities
- Excellent leadership and team development skills
- Superior communication skills (written and verbal)
- Ability to work collaboratively with physicians, clinical staff, and administrative teams
- Proficiency in Microsoft Excel, reporting tools, and data analysis
- Detail-oriented with ability to manage multiple priorities
- Strategic thinking with operational execution capability
- Experience with ENT, Audiology, and/or Plastic Surgery billing
- Experience with surgical scheduling and authorization workflows
Total Rewards The referenced base salary range represents the low and high end of Specialty Care Networks' salary range for this position. Some candidates will not be eligible for the upper end of the salary range. Exact salary will ultimately depend on multiple factors, which may include the successful candidate's geographical location, skills, work experience, market conditions, internal equity, responsibility factor and span of control, education/ training and other qualifications. Specialty Care Network offers a total rewards package that supports our employee's life, career and retirement.
