Sr. Director, Revenue Cycle

Overview

The Sr. Director of Revenue Cycle Operations serves as the executive leader responsible for the strategic development, operational performance, and continued expansion of revenue cycle services across the Health System. This position provides enterprise leadership for revenue cycle operations supporting Central Health specialty services, outpatient services, and CommUnityCare clinical programs while advancing a unified revenue cycle strategy that supports organizational growth, financial sustainability, regulatory compliance, and an exceptional patient experience.

The Sr. Director leads the design, implementation, and optimization of revenue cycle processes spanning patient access, charge capture, coding, billing, claims management, accounts receivable, denial prevention, payment posting, reimbursement optimization, provider education, and revenue integrity. The role is also accountable for enterprise revenue cycle informatics, Epic revenue cycle governance, operational reporting, data analytics, KPI management, benchmarking, and performance improvement initiatives. This position serves as a strategic partner to executive leadership, clinical operations, finance, contracting, compliance, information technology, Epic application teams, and analytics departments to ensure revenue cycle infrastructure supports existing operations and future service line growth, including specialty care, ambulatory services, value-based care initiatives, and new reimbursement models.

Responsibilities

Essential Functions:
Strategic Revenue Cycle Leadership
*Develop and execute a multi-year enterprise revenue cycle strategy aligned with organizational financial, operational, and clinical objectives.
*Build and operationalize revenue cycle infrastructure to support growth of Central Health specialty services and outpatient service lines.
*Lead integration and alignment of revenue cycle operations across Central Health and CommUnityCare.
*Assess organizational readiness for new service lines, payer contracts, ambulatory programs, and future healthcare delivery models.
*Identify opportunities for automation, artificial intelligence, workflow redesign, and technology optimization to improve efficiency and scalability.
*Serve as executive advisor to senior leadership regarding revenue cycle performance, reimbursement trends, and strategic investment opportunities.
*Monitor industry trends, regulatory changes, emerging technologies, and best practices to proactively identify opportunities that improve revenue cycle performance, reimbursement optimization, and operational effectiveness.
Provide strategic and operational oversight for all revenue cycle functions across the health system, including patient access, charge capture, coding, billing, claims management, accounts receivable, denial management,
payment posting, patient financial services, revenue integrity, and provider documentation support.
Ensure operational excellence through performance monitoring, process optimization, regulatory compliance, and cross-functional collaboration to maximize reimbursement, improve cash flow, reduce revenue leakage, and support an exceptional patient experience.

Business Informatics & Analytics Leadership
*Establish and lead the enterprise Revenue Cycle Informatics function.
*Oversee Epic Professional Billing (PB), Claims, Patient Access, Accounts Receivable, and related revenue cycle applications.
*Direct revenue cycle reporting strategy, dashboard development, and KPI governance.
*Ensure data integrity, reporting standardization, and operational transparency across all revenue cycle functions.
*Partner with analytics teams to develop predictive and prescriptive reporting capabilities.
*Lead development of executive dashboards supporting Board, executive, operational, and clinical leadership decision-making.
*Implement benchmarking and performance monitoring against industry standards and best practices.
*Create actionable reporting that translates operational data into measurable improvement opportunities.
Monitor billable revenue, collections, accounts receivable, cash flow, and other revenue cycle measures against established goals and budgets; identify, analyze, and explain significant variances.

Service Line Growth & Operational Readiness
*Lead revenue cycle operational planning for specialty service expansion.
*Collaborate with clinical leadership to establish billing workflows for new ambulatory and specialty programs.
*Ensure appropriate payer enrollment, coding methodologies, charge structures, fee schedules, and
reimbursement optimization strategies.
*Support implementation of new clinical programs, provider recruitment initiatives, and expanded access models.
*Develop operational readiness plans that ensure revenue cycle success during service line launches.

Compliance, Audit & Revenue Integrity
*Ensure compliance with federal, state, FQHC, Medicare, Medicaid, and commercial payer requirements.
*Maintain oversight of coding compliance, documentation standards, and audit programs.
*Lead revenue integrity initiatives designed to prevent revenue leakage and maximize compliant reimbursement.
*Partner with Compliance, Legal, HIM, and Clinical leadership regarding regulatory changes and operational implications.

Leadership & Team Development
*Build and lead a high-performing revenue cycle organization across Central Health and CommUnityCare.
*Develop leadership succession plans and workforce development strategies.
*Establish performance expectations, accountability standards, and professional development pathways.
*Foster a culture of continuous improvement, innovation, collaboration, and data-driven decision-making.
*Lead managers, directors, informatics staff, analysts, and operational teams through organizational growth and transformation.
*Lead the development of scalable workflows, policies, and operational standards that support organizational growth, service line expansion, and long-term financial sustainability.
*Support implementation and administration of value-based contracting models, capitation arrangements, incentive programs, and other alternative payment models, as applicable.
*Collaborate with Finance and other organizational leaders in the development of operating budgets, forecasts, tactical plans, and strategies that support organizational and financial goals.

Payer Strategy, Contracting & Regulatory Support
*Partner with payer contracting and credentialing teams to support contract strategy development, evaluate reimbursement methodologies, analyze proposed contract terms, and assess the financial and operational impact of payer agreements.
*Support implementation and ongoing administration of value-based care arrangements, capitation models, quality incentive programs, and other alternative payment methodologies.
*Collaborate with payers and internal stakeholders to resolve reimbursement, operational, and claims-related issues while monitoring payment trends and identifying opportunities for performance improvement.
*Develop and maintain strong relationships with clinical, operational, financial, payer, and external partners to advance organizational goals and facilitate effective collaboration.
*Provide clear and concise presentations, reports, analyses, and recommendations to executive leadership and other stakeholders, as appropriate.
*Perform other duties as assigned.

Knowledge, Skills and Abilities:

• Advanced knowledge of healthcare revenue cycle management, including eligibility and verification, charge capture, coding, billing, collections, payment posting, accounts receivable, self-pay, and third-party reimbursement.
• Demonstrated financial management skills, including operational and financial analysis, budgeting, forecasting, auditing, accounts receivable analysis, staffing analysis, and financial reporting.
• Demonstrated ability to develop and use key performance indicators and data analytics to evaluate performance, identify risks and opportunities, and drive business decisions.
• Strong knowledge of governmental and commercial payer requirements, reimbursement methodologies, contractual requirements, and healthcare revenue cycle regulations.
• Experience working with electronic medical record, practice management, billing, and other revenue cycle technology platforms.
• Strong understanding of clinical operations and the relationship between clinical documentation, coding, billing, reimbursement, and revenue cycle performance.
• Strong strategic planning, operational leadership, project management, and change management capabilities.
• Ability to develop and implement policies, procedures, strategies, and operational improvements.
• Demonstrated ability to lead, develop, and engage teams while establishing accountability and driving organizational change.
• Exceptional communication, interpersonal, collaboration, and relationship-management skills with the ability to work effectively with clinical, operational, financial, technical, and executive stakeholders.
• Ability to synthesize complex financial and operational information and provide clear analysis, recommendations, and presentations to executive leadership.
• Strong initiative, organization, judgment, and time-management skills with a results-oriented approach.

Qualifications

Minimum Education:

• Bachelor's Degree (higher degree accepted) in business, healthcare administration, finance, accounting, or a related field.

Minimum Experience:

• 5 years of management experience in healthcare revenue cycle operations.
  Demonstrated experience leading revenue cycle functions and teams in a complex healthcare environment.