Director of Revenue Cycle Operations

Description

Job Title: Director of Revenue Cycle Operations

Department: CBO, Revenue Cycle

Reports To: Vice President, Revenue Cycle

Position Summary

                 The Director of Revenue Cycle Operations runs the organization’s day-to-day revenue cycle operations, allowing the Vice President, Revenue Cycle to focus on strategy, payer relationships, and special projects. The Director is accountable for cash performance across collections, coding, billing, payment posting, denials, and payer disputes.

The organization operates freestanding emergency departments primarily out of network. Revenue depends on accurate coding and documentation, timely and well-supported claims, and successful resolution of payer disputes through the No Surprises Act (NSA) Independent Dispute Resolution (IDR) process and Texas Department of Insurance (TDI) processes. The Director owns this cycle from charge capture through cash collected.

The Director manages a team of 15–20 through Associate Directors, leading through people and metrics rather than individual claims. The Director reports results and risks to executive leadership early, with quantified impact and recommended actions, and steps in directly on complex disputes, backlogs, and staffing gaps when needed.

Essential Duties and Responsibilities

• Direct oversight of revenue collections, the revenue integrity program, and auditing; coordinate strategic initiatives; and develop, implement, and update policies, procedures, and performance objectives.
• Manage a team of 15–20 through Associate Directors, including staffing, training, development, performance management, and accountability for results within approved headcount.
• Provide direct leadership to the Associate Directors and oversee daily, weekly, and monthly monitoring activities and operational processes to ensure accurate billing, collections, complete charge capture, appropriate reimbursement, and optimal revenue realization.
• Evaluate and optimize departmental charging and billing workflows to improve charge accuracy, completeness, timeliness, compliance, and reimbursement.
• Monitor, validate, and reconcile revenue across clinical and operational departments to ensure data integrity and consistency between services provided, charges generated, claims submitted, payments received, and contractual reimbursement.
• Assist in the governance, maintenance, and optimization of the Chargemaster (CDM), ensuring accurate descriptions, CPT/HCPCS codes, revenue codes, pricing, billing requirements, and other charge-related components.
• Partner with clinical and operational departments on new revenue initiatives and serve as a subject matter expert in the development and implementation of new Chargemasters, services, procedures, and charging methodologies.
• Oversee collection, coding, payment posting, and reimbursement processes to identify opportunities to prevent avoidable write-offs, underpayments, missed charges, billing errors, and other forms of revenue leakage.
• Provide strategic oversight of denials management, collections, and payment variance activities, collaborating with the Revenue Cycle leadership team and clinical stakeholders to identify root causes, implement corrective actions, and improve financial outcomes.
• Provide leadership and subject matter expertise related to the No Surprises Act (NSA), Independent Dispute Resolution (IDR), Texas Department of Insurance (TDI) requirements, payer disputes, and reimbursement negotiations.
• Own the dispute lifecycle end to end, including open negotiation, determining whether federal IDR or Texas TDI processes apply, offer strategy, filing deadlines, and collection of awards.
• Track dispute results by payer, including win rate, award as a multiple of the qualifying payment amount (QPA), and days to payment, and escalate payers that fail to pay awards on time.
• Establish, monitor, and report key performance indicators (KPIs) related to charge capture, charge reconciliation, denials, collections, reimbursement, revenue leakage, pricing, payment variances, and other revenue integrity activities.
• Analyze financial, billing, claims, payment, and operational data to identify trends, opportunities, control weaknesses, and root causes of revenue cycle issues.
• Report weekly operating results and monthly performance to executive leadership, raising risks and opportunities early with quantified impact and a recommended action.
• Ensure revenue cycle activities comply with applicable CMS requirements, federal and state regulations, payer requirements, privacy laws, contractual obligations, and organizational policies and procedures.
• Ensure the effectiveness, consistency, and integration of revenue cycle processes across the organization while promoting standardized practices, accountability, and operational transparency.
• Lead, mentor, and develop a high-performing revenue cycle team, fostering accountability, collaboration, innovation, professional development, and continuous improvement.
• Collaborate with Revenue Cycle leadership and work with Coding, HIM, Finance, Clinical Operations, Patient Access, Information Systems, and other stakeholders to streamline workflows, eliminate duplicate efforts, strengthen internal controls, and improve revenue cycle performance.
• Support the Vice President, Revenue Cycle on special projects and strategic initiatives involving new service lines, system implementations, organizational changes, acquisitions, regulatory changes, pricing initiatives, payer requirements, and other revenue-impacting activities.
• Perform other duties and special projects as assigned.

Requirements

Education and Experience

• Extensive healthcare revenue cycle experience, with demonstrated expertise in collections, denials management, reimbursement, payer negotiations, the No Surprises Act (NSA), Independent Dispute Resolution (IDR), and Texas Department of Insurance (TDI) requirements.
• Experience in a freestanding emergency department (FSED), emergency medicine, physician practice, or comparable healthcare revenue environment strongly preferred.
• Strong knowledge of healthcare billing, coding, reimbursement methodologies, charge capture, Chargemaster management, and revenue integrity practices.
• In-depth knowledge of applicable healthcare regulations, privacy requirements, CMS guidelines, federal and state regulations, payer requirements, and healthcare billing standards.
• Demonstrated experience analyzing claims, payment data, denials, and revenue cycle performance to identify trends, root causes, and opportunities for financial improvement.
• Experience developing and implementing process improvements, internal controls, best practices, and revenue optimization strategies.
• Demonstrated experience with payer negotiations, reimbursement disputes, payment variances, and resolution of complex billing and reimbursement issues.
• Strong analytical and problem-solving skills, with the ability to interpret complex financial and operational data and translate findings into actionable strategies.
• Excellent written, verbal, communication, presentation, and interpersonal skills, with the ability to effectively collaborate with executive leadership, physicians, clinical teams, and operational stakeholders.
• Demonstrated leadership experience with the ability to build, mentor, and develop high-performing teams.
• Proficiency with healthcare information systems, revenue cycle management platforms, patient access systems, billing systems, Chargemaster applications, reporting tools, and data analytics technologies.
• Ability to manage multiple priorities, lead complex initiatives, and work effectively in a fast-paced, highly regulated healthcare environment.
• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Health Information Management, or a related field preferred; equivalent combination of education and relevant experience may be considered.

Physical Demands

The physical demands for this position include adequate vision, hearing, and repetitive motion. Light physical activity performing non-strenuous daily activities of an administrative nature. Ascending or descending stairs, ramps, and the like, using feet and legs and/or hands and arms. Substantial movements (motions) of the wrist, hands and/or fingers in a repetitive manner. Bending legs downward and forward by bending leg and spine.

Work Environment

Well-lighted, heated and/or air-conditioned indoor office setting with adequate ventilation.