Director of Revenue Cycle Management

Description

The Director of Revenue Cycle Management (RCM) provides strategic leadership and operational oversight for all revenue cycle functions across our multi-state network of 100+ clinical and surgical practices. This executive leader will drive financial performance, optimize billing workflows, streamline claim submissions, and manage clean claim rates, accounts receivable, and denial mitigation.

The ideal candidate brings deep expertise in ophthalmology and surgical RCM, private-equity backed MSO operations, multi-site practice integrations, and system scalability across the East Coast and Mid-Atlantic footprints.

Key Responsibilities

Strategic RCM Leadership & Operations

• Oversee end-to-end revenue cycle operations across 100+ practice locations, including front-end patient intake, insurance verification, authorization, coding, charge capture, billing, collections, and denial management.
• Establish and monitor core revenue cycle KPIs (e.g., Net Collection Rate, Days in A/R, Clean Claim Rate, Cost to Collect, Initial Denial Rate).
• Develop and execute standard operating procedures (SOPs) across all clinical sites to ensure consistency, regulatory compliance, and maximum yield.
• Partner closely with Executive Leadership, Finance, and Practice Administrators to report monthly RCM metrics and financial performance.

Ophthalmology & Surgical Billing Expertise

• Manage      specialized billing processes for comprehensive ophthalmology, optometry, optical retail, and subspecialties (Retina, Cornea, Glaucoma, Oculoplastics, Pediatrics).
• Maintain deep working knowledge of high-volume ophthalmic coding, including surgical global packages, anti-VEGF injection billing/buy-and-bill programs, diagnostic testing, and optical claims.
• Ensure compliance with CMS, commercial payer rules, local coverage determinations (LCDs), and state/federal healthcare regulations.

M&A Integration & System Optimization

• Lead RCM integration for newly acquired practices, harmonizing legacy billing systems, credentialing protocols, and front-desk workflows into the centralized enterprise model.
• Optimize enterprise PM/EHR systems (e.g., NextGen, Modernizing Medicine/EMA, Epic, ManagementPlus) and clearinghouse integrations to automate billing operations.
• Standardize position control protocols and train Practice Administrators on front-end revenue cycle responsibilities.

Vendor & Team Leadership

• Direct,      mentor, and evaluate the internal revenue cycle team (managers, certified coders, billing specialists, and credentialing coordinators).
• Manage strategic partnerships with external third-party RCM vendors, billing teams, and clearinghouses; conduct performance audits to maintain SLAs.
• Lead credentialing and payer enrollment processes across expanding multi-state provider networks.

Qualifications & Requirements

• Education:      Bachelor’s degree in Healthcare Administration, Business, Finance, correlated field required; Master’s degree (MHA/MBA) preferred.
• Experience: Minimum 7–10+ years of progressive healthcare revenue cycle leadership, with at least 3–5 years leading RCM across a multi-site      network (50+ locations preferred).
• Specialty Knowledge: Prior experience in ophthalmology, ambulatory surgery centers (ASCs), or eye care MSOs strongly preferred.
• Systems Expertise: Hands-on experience with top ophthalmology practice management platforms (e.g., Modernizing Medicine EMA, NextGen, Epic, ManagementPlus).
• Certifications: Certified Revenue Cycle Executive (CRCE), Certified Professional Coder (CPC), or Certified Healthcare Financial Professional (CHFP) is a plus.
• Multi-State Footprint: Proven track record of managing multi-state payer mixes (Medicare, Medicaid, commercial, vision plans) throughout the East Coast and Mid-Atlantic regions.

Core Competencies

• Change Management: Ability to drive operational alignment and process discipline during rapid growth and practice acquisitions.
• Analytical Mindset: Expert in financial reporting, revenue integrity audits, and leverage data to identify root-cause denial trends.
• Cross-Functional Communication: Skilled at collaborating with clinical staff, Practice Administrators, and executive management to drive financial results.