POSITION PURPOSE

The Revenue Cycle Management Director is a highly skilled and strategic senior leadership role responsible for leading and optimizing all aspects of the organization's revenue cycle operations. This leader will be responsible for ensuring the financial health and sustainability of the organization through effective management of billing, coding, claims processing, collections, reimbursement optimization, payer relations, denial management, and revenue integrity initiatives.

Reporting directly to the Chief Financial Officer (CFO), the Revenue Cycle Management Director will serve as a key operational and financial leader, partnering closely with Clinical Operations, Quality, Compliance, Contracting, Provider Relations, Information Technology, and Executive Leadership to ensure efficient revenue capture, accurate reimbursement, and compliance with all regulatory and contractual requirements.

The ideal candidate will possess extensive experience in healthcare revenue cycle operations, Medicare Advantage, Medicaid, value-based care models, risk adjustment reimbursement methodologies, and population health payment structures. This individual will be responsible for identifying opportunities to improve cash flow, reduce denials, optimize reimbursement, enhance operational efficiencies, and support organizational growth initiatives.

The Revenue Cycle Management Director will lead a small but highly effective team while developing scalable processes, leveraging data analytics, and fostering a culture of accountability, customer service, continuous improvement, and financial stewardship.

This position reports to the Phoenix office (conveniently located off SR-51, Glendale Avenue, and 16th Street) and operates on a hybrid schedule of three days per week in the office and two days per week in the field.

DUTIES & RESPONSIBILITIES

Revenue Cycle Leadership & Strategy

• Provide strategic oversight and leadership for all revenue cycle functions, including patient eligibility verification, charge capture, coding review, claims management, payment posting, collections, denial management, and reimbursement optimization.
• Develop and execute revenue cycle strategies that align with organizational financial goals and growth initiatives.
• Establish department objectives, performance standards, and key performance indicators (KPIs) that support operational excellence and financial performance.
• Collaborate with executive leadership to identify opportunities to enhance revenue integrity and maximize reimbursement.
• Develop annual departmental goals, budgets, staffing plans, and operational roadmaps.

Billing, Claims & Reimbursement Management

• Oversee all billing and claims submission activities to ensure timely, accurate, and compliant reimbursement.
• Monitor claims lifecycle performance, including clean claim rates, first-pass resolution rates, days in accounts receivable, denial rates, and collection effectiveness.
• Ensure appropriate billing practices are followed for Medicare, Medicaid, commercial payers, and value-based care contracts.
• Lead initiatives to improve claim accuracy and reduce preventable denials.
• Analyze reimbursement trends and implement corrective actions to improve collections and cash flow.

Denials & Revenue Integrity

• Develop and oversee comprehensive denial management programs.
• Monitor denial trends and root causes to identify opportunities for process improvement.
• Collaborate with operational and clinical leaders to resolve documentation, coding, and workflow issues impacting reimbursement.
• Establish corrective action plans to address recurring revenue leakage and reimbursement challenges.
• Ensure proper revenue capture through auditing, monitoring, and education initiatives.

Contract & Payer Management

• Partner with Finance and Contracting teams to evaluate payer contracts and reimbursement methodologies.
• Monitor payer performance and reimbursement compliance.
• Serve as a key point of contact for payer escalations, reimbursement disputes, and operational concerns.
• Analyze payer trends and identify opportunities to improve contract performance.
• Support negotiations by providing operational and financial reimbursement insights.

Population Health & Value-Based Care Support

• Collaborate with Quality, Clinical Operations, and Population Health leadership to align revenue cycle processes with value-based care initiatives.
• Support reimbursement strategies related to Medicare Advantage, Medicaid, risk adjustment, HCC coding, quality incentive programs, STARS, HEDIS, and shared savings arrangements.
• Monitor financial performance related to quality-based reimbursement opportunities.
• Partner with operational teams to ensure documentation supports appropriate reimbursement and quality outcomes.

Financial Analysis & Reporting

• Develop and maintain revenue cycle dashboards and financial performance reports.
• Analyze revenue trends, collections, payer performance, denial patterns, and operational metrics.
• Present regular financial and operational updates to the CFO and executive leadership team.
• Utilize data analytics to identify opportunities for process optimization and revenue enhancement.
• Support organizational budgeting and forecasting activities related to revenue cycle operations.

Compliance & Regulatory Oversight

• Ensure compliance with CMS, Medicare, Medicaid, HIPAA, OIG, state regulatory agencies, and payer contractual requirements.
• Maintain current knowledge of healthcare reimbursement regulations and industry best practices.
• Support internal and external audits related to billing, coding, reimbursement, and revenue cycle operations.
• Develop policies and procedures that support compliance and operational excellence.
• Collaborate with Compliance and Quality leadership to address regulatory findings and implement corrective actions.

Team Leadership & Staff Development

• Directly supervise and mentor Revenue Cycle staff, fostering a culture of accountability, collaboration, and continuous improvement.
• Establish performance expectations and conduct regular performance evaluations.
• Identify training needs and develop educational programs to enhance staff competencies.
• Promote employee engagement, retention, and professional development.
• Ensure adequate staffing levels and workload distribution to meet departmental goals.

Process Improvement & Technology Optimization

• Evaluate and improve revenue cycle workflows to increase efficiency and effectiveness.
• Partner with Information Technology and operational leaders to optimize system functionality and reporting capabilities.
• Lead process improvement initiatives utilizing Lean, Six Sigma, and best-practice methodologies.
• Identify automation opportunities that improve accuracy, productivity, and financial performance.
• Support implementation of new technologies, billing systems, and process enhancements.

Organizational Collaboration

• Collaborate with Finance, Clinical Operations, Quality, Compliance, Provider Relations, Credentialing, and Executive Leadership to achieve organizational objectives.
• Serve as a trusted advisor to leadership regarding revenue cycle performance and reimbursement strategy.
• Participate in organizational committees, strategic planning initiatives, and leadership meetings.
• Foster strong working relationships with providers, health plans, vendors, and business partners.

Additional Responsibilities

• Travel as necessary to support operational needs, provider engagement, and business initiatives.
• Participate in special projects and organizational initiatives as assigned.
• Other duties as assigned.

SKILLS & QUALIFICATIONS

• Seven (7) years of progressive healthcare revenue cycle experience.
• Three (3) years of leadership experience managing revenue cycle, billing, collections, or reimbursement teams.
• Strong understanding of healthcare reimbursement methodologies, including Medicare, Medicaid, Medicare Advantage, commercial insurance, and value-based care payment models.
• Experience supporting population health, managed care, risk adjustment, or value-based reimbursement programs preferred.
• Knowledge of HCC coding, risk adjustment methodologies, STARS, HEDIS, and quality incentive reimbursement models preferred.
• Demonstrated success improving accounts receivable performance, collections, denial rates, and reimbursement outcomes.
• Experience analyzing financial and operational data to drive decision-making.
• Strong project management and process improvement capabilities.
• Exceptional leadership, communication, coaching, and relationship-building skills.
• Ability to effectively collaborate with executive leadership and cross-functional teams.
• Experience managing vendor relationships and outsourced revenue cycle services preferred.
• Strong analytical, organizational, and problem-solving skills.
• Ability to thrive in a fast-paced, rapidly growing healthcare environment.
• Proficiency with revenue cycle systems, electronic health records, practice management systems, and Microsoft Office Suite.

EDUCATION, LICENSES, & CERTIFICATIONS

• Bachelor's degree in healthcare administration, business administration, finance, accounting, health information management, or a related field required.
• Master's degree in healthcare administration (MHA), business administration (MBA), finance, or a related field preferred.
• Certified Revenue Cycle Executive (CRCE), Certified Healthcare Financial Professional (CHFP), Certified Professional Coder (CPC), Certified Professional Biller (CPB), or equivalent certification strongly preferred.
• Lean Six Sigma certification preferred.

BENEFITS & TOTAL REWARDS

• Paid Orientation and Training
• Insurance - Medical, Dental, Vision, and Life
• 401k Plan - 3% match
• Employee Assistance Program
• Tuition Reimbursement
• Continued Education Support
• Mileage Reimbursement (if applicable)
• Referral Bonuses
• Paid Holidays (9 days)
• Flexible Time Off
• Paid Volunteer Hours

CHARACTER & COMPETENCIES

• Courage - To have the courage to do the right thing at the right time.
• Ownership - To take ownership of every issue you touch.
• Respect - To respect yourself, co-workers, and for those whom you care.
• Excellence - To be excellent in all that you do.
• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethics; Upholds organizational values.
• Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
• Judgement - Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
• Problem-Solving - Identifies and resolves problems promptly; Gathers and analyzes information skillfully; Develops alternative solutions; Works well in group problem-solving situations; Uses reason even when dealing with emotional topics.
• Professionalism - Tactfully approaches others; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through with commitments.
• Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succe