Director, Revenue Cycle Management

Description

The Revenue Cycle Management (RCM) Manager is responsible for overseeing and managing all aspects of the medical billing and collections processes to ensure efficient, accurate, and timely revenue generation. This role supervises the RCM team, including claims inventory and payment posting operations, while optimizing workflows for both on-site and remote staff. The RCM Manager plays a key role in ensuring compliance with regulatory requirements, resolving system issues, and maintaining the integrity of financial and operational reporting. Additionally, this position develops and implements strategies to enhance revenue cycle performance, optimize processes, and meet organizational financial goals.

Requirements

Key Responsibilities

Revenue Cycle Operations Management

• Oversee and manage the medical billing staff and collections team to ensure accurate and timely submission of claims and encounter data.
• Direct the day-to-day operations of the claims inventory team, coordinating workflows for on-site and remote employees.
• Supervise the claims payment posting process to ensure accuracy and consistency in data entry methodologies.
• Identify opportunities to enhance revenue cycle efficiency and implement process improvements to maximize reimbursement.

System Optimization and Reporting

• Manage system-related issues affecting billing, claims processing, and collections operations.
• Optimize the use of RCM and billing systems for daily operations while maintaining data integrity and system reporting capabilities.
• Generate, analyze, and present reports on RCM performance metrics, including claims submissions, denials, collections, and payment trends.

Compliance and Regulatory Oversight

• Ensure compliance with all federal, state, and local regulations, including CMS standards and Health Plan guidelines.
• Establish and maintain consistent referral and billing processes in compliance with regulatory requirements and organizational policies.
• Serve as the department’s subject matter expert on revenue cycle compliance, providing guidance on CMS and payer-specific billing issues.

Leadership and Team Development

• Provide direct supervision, training, and mentorship to the RCM team to promote professional growth and enhance team performance.
• Conduct regular performance evaluations, provide feedback, and implement development plans for team members.
• Foster a collaborative and high-performance team culture to meet organizational revenue cycle goals.

Collaboration and Strategic Planning

• Collaborate with leadership and other departments to address operational inefficiencies and improve RCM workflows.
• Act as the primary point of contact for RCM-related inquiries and provide cross-departmental support as needed.
• Participate in strategic planning to align revenue cycle goals with organizational objectives and financial targets.

Qualifications

Education and Certification

• Bachelor’s degree in Healthcare Administration, Business, Accounting, or a related field required.
• Certification in Medical Billing and Coding or Revenue Cycle Management (e.g., CRCR, CPC, CPB) preferred.

Experience

• Minimum of 5 years of progressive experience in revenue cycle management, medical billing, or healthcare operations, with at least 2-3 years in a leadership role.
• Proven experience in claims processing, payment posting, denial management, and collections operations.
• Expertise in CMS standards, payer-specific guidelines, and regulatory compliance.
• Hands-on experience with RCM systems and electronic medical records (EMR).

Skills and Abilities

• Strong leadership and team management skills, with the ability to lead on-site and remote teams effectively.
• Advanced knowledge of revenue cycle processes, including billing, collections, and claims workflows.
• Proficiency in billing software, RCM tools, and reporting systems, as well as Microsoft Office Suite (Excel, Word, etc.).
• Exceptional analytical and problem-solving skills to identify trends, resolve system issues, and improve financial outcomes.
• Excellent communication and interpersonal skills to collaborate with internal teams and external stakeholders.
• Highly organized, with strong attention to detail and the ability to manage multiple projects simultaneously.

Key physical and mental requirements:

• Ability to lift up to 50 pounds
• Ability to push or pull heavy objects using up to 50 pounds of force
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving
• Ability to travel to multiple locations to support business needs as required

FLSA Classification: Exempt

Southeast Primary Care Partners is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.

12/2024