Director of Revenue Integrity & Cycle Management
6 days ago
Miami
Job Description Key Responsibilities Revenue Cycle Management • Oversee the complete revenue cycle, including charge capture, claim submission, payment posting, collections, denials, appeals, and A/R management., • Establish and monitor departmental KPIs for billers, collectors, posters, and other RCM staff., • Monitor aging, collection rates, clean claim rates, denial rates, days in A/R, payment posting, and other key performance indicators., • Ensure claims are submitted accurately and timely and that outstanding balances are appropriately worked., • Develop strategies to reduce A/R, improve cash collections, and prevent avoidable denials. Revenue Integrity & Compliance • Ensure services are accurately documented, coded, charged, and billed in accordance with payer requirements and applicable regulations., • Monitor charge capture and coding processes to identify missed charges, incorrect coding, underpayments, and potential revenue leakage., • Partner with coding and clinical teams to address documentation and coding deficiencies., • Maintain appropriate controls for contractual adjustments, write-offs, refunds, and account corrections., • Conduct periodic audits to identify revenue integrity and compliance risks. Denials & Reimbursement • Oversee denial management and establish processes for timely follow-up, appeals, and root-cause analysis., • Identify trends involving payer denials, authorization issues, coding errors, credentialing problems, and reimbursement discrepancies., • Monitor payer reimbursement to identify underpayments and contract-related issues., • Collaborate with Credentialing and Contracting to resolve payer enrollment and reimbursement issues. Payment Posting & Reconciliation • Ensure payments, adjustments, and patient collections are posted accurately and timely., • Establish controls for unapplied payments, credit balances, refunds, and posting discrepancies., • Partner with Finance to reconcile billing system activity to bank deposits and financial reporting., • Ensure month-end revenue cycle reconciliation is completed accurately and within established deadlines. Leadership & Performance Management • Lead, develop, and hold accountable the billing and revenue cycle management team., • Establish clear productivity and quality expectations for all RCM functions., • Review staffing levels and recommend changes based on workload, productivity, and organizational needs., • Develop standardized workflows, policies, procedures, and SOPs., • Provide ongoing training and performance coaching., • Hold regular operational meetings to review KPIs, barriers, outstanding A/R, denials, and collection performance. Reporting & Analytics • Develop and maintain daily, weekly, and monthly revenue cycle reporting., • Provide leadership with accurate reporting on collections, A/R, denials, payment trends, and projected cash collections., • Identify discrepancies between billing system reports, bank activity, and financial statements and ensure timely resolution., • Present revenue cycle performance, risks, corrective actions, and improvement initiatives to executive leadership. Qualifications • Bachelor’s degree in Healthcare Administration, Business, Finance, Accounting, or related field preferred., • Minimum 5–7 years of healthcare revenue cycle experience, including management responsibility., • Strong experience with physician billing and preferably ambulatory surgery center, anesthesia, pathology, infusion, or other ancillary billing., • Strong understanding of Medicare, Medicaid, commercial insurance, managed care, and payer reimbursement., • Knowledge of CPT, ICD-10, HCPCS, coding, charge capture, claims processing, denials, and reimbursement methodologies., • Demonstrated experience managing A/R, collections, payment posting, denials, and revenue reconciliation., • Strong analytical and financial reporting skills., • Experience establishing KPIs, SOPs, internal controls, and performance-management processes., • Experience with healthcare practice management and billing systems; eClinicalWorks experience is a plus. Reporting Structure Reports to: Executive Leadership Direct Oversight: Billing, Collections, Payment Posting, Denials/Appeals, Revenue Integrity, and other Revenue Cycle functions as assigned.