DescriptionJob Summary The Executive Director of Revenue Cycle leads the end-to-end revenue cycle across Nicklaus Children's Health System. Provides oversight of front-end, mid-cycle, and back-end revenue functions and is accountable for achieving performance targets. Partners closely with operational leaders, Managed Care, Finance, IT, and external vendors to drive sustainable financial performance, operational efficiency, and a high-quality patient experience aligned with the organization's mission to deliver exceptional pediatric care.
Job Specific Duties - Lead and optimize all components of the revenue cycle, including:
- Patient access (scheduling, registration, authorization, financial counseling)
- Case Management, Social Work, Pastoral Services, and Transfer Center
- Health information management (HIM), coding and CDI
- Revenue integrity, Charge Description Master (CDM), charge capture, and billing
- Patient financial services, A/R follow up, Appeals and Underpayments, Cash/Credit Management, and Customer Service
- Ensure seamless coordination across all functions to achieve timely and accurate revenue capture and reimbursement.
- Lead governance and performance management of the organization's outsourced revenue cycle vendor(s), inlcluding:
- Establishing and enforcing SLAs tied to key KPIs (e.g., net collection rate, AR days, denial rate)
- Conducting regular business and performance scorecard reviews
- Driving continuous improvement and corrective action plans for underperformance
- Partnering on optimization initiatives (automation, AI, workflow redesign)
- Oversee contract performance, escalation management, and alignment of vendor operations with system goals.
- Oversee key revenue cycle metrics, including, but not limited to:
- Days in AR-
- Denial rates-
- Net collection rate, including complex large balance claims-
- Bad debt performance-
- Excess/Avoidable Days
- Coding accuracy
- Point of Service Collections
- Call Center and Pre-Access Metrics: Speed to Answer, Accuracy, Authorization Days Out, etc.
- Patient Financial Experience
- Develop and maintain a structured performance reporting framework and accountability forums.
- Analyze trends and implement targeted initiatives to improve financial outcomes.
- Partner with leadership and vendor partners to define and execute a multi-year revenue cycle strategy:
- Technology optimization (e.g., EMR revenue cycle platforms, automation, analytics tools)
- Shared services and operating model design
- Integration of vendor and internal workflows
- Collaborate with IT teams and vendors to identify system enhancements and ensure alignment with business needs.
- Ensure adherence to all regulatory, payer, and compliance requirements (IRS, OIG, CMS, HIPAA, payer contracts).
- Mitigate financial risk through strong internal controls and processes.
- Lead and develop a high-performing revenue cycle organization, including internal leaders and vendor teams.
- Establish clear accountability structures, performance expectations, and training programs.
- Foster a culture of continuous improvement, collaboration, and service excellence.
- Demonstrate strong communication and collaboration skills across the enterprise.
- Partner with clinical and operational leaders to enhance transparency and the overall patient financial experience.
- Ensure patient-friendly billing practices and effective patient financial assistance programs.
Qualifications Minimum Job Requirements - Bachelor's Degree in Business or Healthcare Administration
- 7-10 years of progressive experience in the healthcare revenue cycle
- Healthcare industry financial statistical indicators experience
Knowledge, Skills, and Abilities - Master's degree preferred.
- HFMA, AAHAM, or similar professional certification preferred.
- Epic experience preferred.
- Florida Medicaid experience preferred.
- Proven ability to lead large-scale operational and transformation initiatives.
- Deep understanding of end-to-end revenue cycle processes, including, billing, coding, reimbursement, and denial management.
- Strong leadership and communication skills.
- Experience in negotiating contracts and resolving vendor/service issues.
- Demonstrated experience managing outsourced revenue cycle vendors or shared services models.
- Knowledge of healthcare regulatory requirements and payer dynamics.
