JOB SUMMARY:This position is responsible for providing strategic oversight of medical and pharmacy billing operations to ensure accurate, timely, and compliant claim submission, reimbursement processing, and revenue recognition. This role leads billing performance, reimbursement optimization, denial and pending revenue management, and payer compliance initiatives to maximize financial outcomes. The Director drives operational excellence through analytics, automation, process improvement, and cross-functional collaboration to enhance billing quality, efficiency, and overall revenue cycle performance.
ESSENTIAL DUTIES AND RESPONSIBILITIES:1. Provide strategic leadership and oversight of medical and pharmacy billing operations to ensure timely, accurate, and compliant claim submission, invoice generation, and revenue recognition.
2. Develop and execute billing strategies that improve clean claim rates, reduce billing errors and payer rejections, and optimize reimbursement performance.
3. Lead revenue cycle initiatives focused on reducing pending revenue, resolving billing barriers, and accelerating cash flow through effective cross-functional collaboration.
4. Establish, implement, and continuously improve billing workflows, operational standards, policies, and procedures to support quality, consistency, scalability, and operational excellence.
5. Monitor and analyze key performance indicators, operational dashboards, and billing analytics to identify trends, mitigate revenue risk, and drive data-informed decision-making.
6. Ensure compliance with all applicable payer, reimbursement, regulatory, and organizational requirements while adapting operations to changing healthcare regulations and industry standards.
7. Lead automation, technology, and process improvement initiatives that increase efficiency, strengthen quality controls, and enhance overall billing performance.
8. Partner with Information Technology, Business Applications, Revenue Cycle, and operational leaders to implement system enhancements, reporting solutions, and workflow optimization strategies.
9. Provide leadership and oversight of domestic and offshore billing teams by establishing performance expectations, productivity standards, quality metrics, and accountability measures.
10. Develop, coach, and retain high-performing leaders and staff while fostering a culture of collaboration, continuous improvement, innovation, and professional growth.
11. Collaborate with payer, pricing, contracting, and operational teams to implement billing strategies that maximize reimbursement and support organizational objectives.
12. Serve as a strategic partner to executive leadership by providing operational insights, performance reporting, and recommendations that strengthen revenue cycle outcomes and support organizational growth.
13. Other related duties as assigned by manager or designee.
JOB REQUIREMENTS AND QUALIFICATIONSEducation:
• Bachelor's degree in business or financial field required
• Master's degree in business, finance, or health care related field preferred.
Experience:
• Minimum of seven (7) years in revenue cycle management or health care consulting required.
• Purchasing experience preferred.
• Experience in home health, infusion pharmacy services preferred.
• Proficient experience with Microsoft Office including Word, Excel, PowerPoint, Outlook, Teams, and CPR+ software system or similar system preferred.
Skills and Competencies:
• Knowledge of medical and pharmacy billing operations, reimbursement processes, and payer requirements; 340B knowledge preferred.
• Strong leadership, decision-making, and problem-solving skills.
• Ability to manage multiple priorities, projects, and deadlines with strong follow-through.
• Strong organizational skills and attention to detail.
• Effective verbal and written communication skills, including the ability to work with employees, leaders, and cross-functional teams.
• Ability to lead change, drive process improvements, and gain support for new initiatives.
• Strong analytical skills with the ability to use data and performance metrics to improve operational results.
• Demonstrated integrity, accountability, and professionalism in all aspects of leadership and operations.
What we offer: - Competitive compensation
- Benefits start on your 1st day of employment
- 401k w 4% match - no waiting or vesting period
- PTO / Floating Holidays / Paid Holidays
- Company paid life insurance, short term disability
- Employee Assistance programs to help with mental health / wellness
- Learning & Development Programs
- Perks... includes discounts on travel, cell phone, clothing and more...
- Generous employee referral program
