General Summary: The Revenue Cycle Management Director provides strategic and operational leadership for the organization's revenue cycle functions, with accountability for AR days, net collection rate, accurate revenue capture, timely month-end close support, clean AR aging, reconciliation analysis, and audit readiness. This role oversees billing, claims, payment posting, AR follow-up, denial management, revenue integrity, analytics, and related controls to improve cash flow, reduce avoidable write-offs, and support accurate financial reporting.
Job Responsibilities: Leadership and Strategic Management- Provide leadership, direction, and oversight of all Revenue Cycle operations.
- Set departmental goals, performance standards, and KPI targets aligned with organizational priorities.
- Promote accountability, service quality, process improvement, and data-driven performance management.
- Recruit, develop, mentor, and retain high-performing revenue cycle staff.
- Establish and monitor staffing levels, workload distribution, productivity, and service standards.
- Hold managers and staff accountable for AR follow-up, claims resolution, payment posting, productivity, and close deliverables.
- Serve as the liaison between Revenue Cycle, Finance, Operations, Information Systems, and clinical programs.
Revenue Cycle Operations - Direct the end-to-end revenue cycle process, including:
- Eligibility verification
- Claims preparation and submission
- Payment posting
- Accounts receivable follow-up
- Denial management
- Appeals and recovery efforts
- Refunds and credit balances
- Revenue reconciliation
- Ensure claims are submitted accurately and within payer-required timeframes.
- Monitor claim lag, payment posting, denials, and payer issues to remove bottlenecks and support AR days below 40 days.
- Oversee payer enrollment, credentialing coordination, EFT/ERA management, and billing system configuration.
- Ensure consistent application of billing policies, coding requirements, reimbursement methodologies, and payer guidelines.
- Establish and maintain standard operating procedures and workflow documentation.
- Ensure billing, posting, follow-up, denials, and AR work queues meet established service levels.
Accounts Receivable and Collections - Maintain AR days below 40 days by reducing aged balances and improving collections.
- Monitor AR aging, denials, collection effectiveness, bad debt exposure, and payer performance.
- Develop corrective action plans for backlog reduction and revenue recovery.
- Maintain a clean AR aging report with documented ownership, follow-up status, root causes, and resolution timelines.
- Ensure timely resolution of denied, underpaid, and rejected claims.
- Maintain net collection rate above 99% and bad debt write-offs below 1%.
- Partner with operational leaders to resolve documentation, authorization, and billing issues impacting reimbursement.
Revenue Integrity and Financial Performance - Ensure complete and accurate revenue capture through charge review, billing validation, contract monitoring, and revenue leakage controls.
- Provide analysis, schedules, and variance explanations for AR, deferred revenue, billing, cash, and general ledger reconciliations.
- Complete revenue cycle month-end and year-end close deliverables accurately and on schedule with a target of 3rd business day.
- Analyze reimbursement trends, payer performance, and contract compliance.
- Review adjustments, write-offs, refunds, and credit balances for accuracy, authorization, financial impact, and policy compliance.
- Support contract negotiations by providing reimbursement and financial analysis.
Data Analytics and Reporting - Work with Information Systems to maintain KPI dashboards for AR days, collection rate, bad debt, AR aging, denials, close readiness, reconciliation status, and audit support.
- Report monthly KPI results, trends, variances, corrective actions, and responsible owners to executive leadership.
- Utilize revenue cycle and EHR system data to identify operational improvement opportunities.
- Present actionable recommendations based on financial and operational analyses.
- Track current results, targets, prior-period trends, root causes, and expected resolution dates for KPIs outside target.
Compliance and Risk Management - Ensure compliance with:
- Medicaid and Medicare regulations
- Commercial payer requirements
- HIPAA Privacy and Security Rules
- Organizational policies and procedures
- Maintain audit readiness through complete documentation, reconciliations, write-off approvals, payer support, and timely audit schedules.
- Collaborate with Compliance, Internal Audit, and Finance leadership to address findings and mitigate risks.
Systems and Process Improvement - Partner with Information Systems and EHR teams on system configuration, testing, implementation, and optimization.
- Lead revenue cycle technology initiatives and automation projects.
- Evaluate system enhancements that improve revenue recognition, billing accuracy, and operational efficiency.
- Support ERP and EHR integration initiatives.
Qualifications: Minimum Education Required: Bachelor's Degree in Healthcare Administration, Business Administration, Finance, Public Health or related field.
Minimum Experience Required: Seven (7) or more years of progressive healthcare revenue cycle experience with demonstrated improvement in AR, collections, denials, revenue integrity, reconciliations, and close support. Five (5) or more years of leadership experience managing billing, claims, accounts receivable, collections, or related functions. Experience with Medicaid managed care, Medicare, commercial insurance, and behavioral health reimbursement preferred. Experience in multi-entity healthcare or nonprofit organizations preferred. Experience with EHR systems, preferably Netsmart myAvatar and advanced reporting tools is required.
Preferred Education: Master's Degree
Regulatory Requirements: - Minimum 18 years of age.
- Valid AZ DPS Level I fingerprint clearance card (must maintain valid card throughout employment).
Questions about this position? Contact us at HR@ichd.net.
