Director of Revenue Cycle - Professional Services | Summit Healthcare Mgmt | Nashville, Tennessee
About the Job:PURPOSE STATEMENT:
Position Summary
The Director-Revenue Cycle Professional Services is responsible for leading and optimizing daily accounts receivable operations across the revenue cycle. This role provides both strategic direction and hands-on operational oversight to accelerate cash collections, reduce aged receivables, minimize avoidable write-offs, and strengthen denial prevention and recovery performance.
The Director partners cross-functionally to resolve payment barriers, improve first-pass resolution, and ensure consistent, high-quality execution of follow-up and denial workflows across all payer classes, including government, commercial, managed care, and self-pay.
Roles and Responsibilities:ESSENTIAL FUNCTIONS:Revenue Cycle Operations Leadership- Lead end-to-end revenue cycle operations including billing, collections, denial management, insurance follow-up, cash posting, reconciliation, and customer service, ensuring accurate and timely workflow execution.
- Maintain direct oversight of daily operations, including claim generation, edits, holds, rebills, corrections, billing release, work queues, aging reports, and escalation pathways.
- Ensure compliance with payer requirements, coding and documentation dependencies, internal policies, and contractual obligations.
- Establish, refine, and enforce standard work, operational policies, internal controls, and escalation protocols while maintaining audit readiness.
Billing, Payments, and Reconciliation Oversight- Oversee all billing functions to ensure timely, accurate claim submission, clean-claim performance, and reduced billing lag and rejections.
- Direct all payment posting and cash management activities, including electronic remittances, manual posting, adjustments, denials at posting, refunds, and unapplied cash workflows.
- Maintain oversight of reconciliation processes, ensuring alignment between cash, EFT, lockbox, credit card, and manual payments with the general ledger and bank reporting.
- Monitor credit balances, posting variances, and unapplied cash aging, implementing corrective actions and process improvements as needed.
- Partner with Finance and Treasury on reconciliation, month-end close, and audit support, while resolving complex reconciliation issues.
Denial Management & Insurance Follow-Up- Lead all denial management activities including intake, classification, prioritization, trending, prevention, and appeals.
- Ensure timely and accurate denial resolution and appeal submission within payer filing requirements.
- Oversee insurance follow-up to maximize reimbursement, including resolution of underpayments, rejections, no-response claims, payer correspondence, and credit balance issues.
- Monitor payer performance, identify reimbursement barriers, and drive corrective actions in collaboration with contracting, compliance, and operational teams.
- Maintain visibility into high-risk, high-volume, or high-dollar accounts and intervene to ensure resolution and prevent recurrence.
Customer Service Operations- Lead patient/customer service functions, ensuring accurate, timely, and professional communication regarding balances, billing inquiries, and account status.
- Monitor and improve service metrics including call quality, service levels, abandonment rates, first-contact resolution, and escalation trends.
- Oversee complaint resolution and service recovery efforts to ensure a positive patient financial experience.
- Develop and refine scripts, workflows, and training to ensure consistency, compliance, and service excellence.
Team Leadership & Workforce Management- Lead a multi-level team including managers, supervisors, leads, and frontline staff across all revenue cycle functions.
- Provide hands-on leadership through coaching, quality reviews, productivity oversight, and performance management.
- Oversee staffing models, workforce planning, hiring, and onboarding to support operational demands and growth.
- Foster a culture of accountability, urgency, accuracy, ownership, and continuous improvement.
- Ensure teams are trained and aligned with payer requirements, workflows, denial trends, and organizational expectations.
Performance Management & Analytics- Monitor and analyze operational performance across billing, cash posting, reconciliation, AR, denials, and customer service functions.
- Track and drive improvement in key metrics including claim volume, clean-claim rates, AR aging, denial rates, timely filing, productivity, and collection performance.
- Maintain regular review of dashboards and KPIs, taking proactive corrective actions to address risks and gaps.
- Prepare and present operational summaries, insights, and performance trends to senior leadership.
Cross-Functional Collaboration & Process Improvement- Partner with Patient Access, HIM, Coding, Utilization Review, Case Management, Finance, Treasury, and clinical teams to resolve barriers impacting reimbursement and operational efficiency.
- Identify systemic issues affecting claim accuracy, denials, and collections, and implement targeted process improvements.
- Lead workflow redesign, automation initiatives, system enhancements, and process standardization efforts.
- Maintain strong frontline engagement to ensure alignment between strategic objectives and daily execution.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS: - Bachelor's degree in Healthcare Administration, Business, Finance, or related field preferred; equivalent relevant experience may be considered in lieu of degree.
- Five or more years of progressive healthcare revenue cycle experience required.
- Experience in hospital, behavioral health, acute care, physician revenue cycle, or multi-site healthcare operations preferred.
- Strong knowledge of payer reimbursement, denial management, appeals, claims adjudication, and account resolution workflows.
- Working knowledge of payer rules, timely filing requirements, authorization requirements, and reimbursement regulations.
- Strong analytical, problem-solving, leadership, and communication skills.
- Proficiency with EMR/PMS platforms, clearinghouses, payer portals, and Microsoft Excel.
- Experience in behavioral health, SUD, acute psych, or multi-facility healthcare environments preferred.
LICENSES/DESIGNATIONS/CERTIFICATIONS:HFMA, CRCR, or similar revenue cycle certification preferred.
WORK LOCATION:This position is hybrid position of remote and on-site at the Company's headquarters in Franklin, TN.
SUPERVISORY REQUIREMENTS: Three or more years of physician revenue cycle leadership required.
