Director of Revenue
hace 7 días
Buffalo
Job Description Director of Billing & Revenue Position Summary UBMD Orthopaedics & Sports Medicine is seeking an experienced and strategic Director of Billing & Revenue to lead all aspects of the organization's physician billing and revenue cycle operations. As the largest orthopaedic practice in Western New York, the Director of Billing plays a critical leadership role in ensuring accurate reimbursement, regulatory compliance, operational efficiency, and exceptional financial performance across multiple clinical locations and subspecialties. The Director of Billing is responsible for the oversight and continuous improvement of all physician billing functions, including charge capture, coding collaboration, claims processing, payment posting, accounts receivable management, denial prevention and resolution, payer relations, and patient billing. This position partners closely with physicians, practice leadership, coding, finance, compliance, and operational teams to maximize reimbursement while maintaining the highest standards of accuracy and compliance. Essential Duties and Responsibilities • Provide strategic leadership and operational oversight of all physician billing and revenue cycle functions., • Develop and execute departmental goals, key performance indicators (KPIs), and performance improvement initiatives aligned with organizational objectives., • Lead billing operations to ensure timely charge entry, clean claim submission, payment posting, collections, denial management, and accounts receivable follow-up., • Oversee billing processes for orthopaedic surgery, sports medicine, physical therapy, imaging, durable medical equipment (DME), and other ancillary services., • Ensure accurate reimbursement for surgical procedures by maintaining expertise in global surgical packages, modifiers, multiple procedure reductions, bundled services, and payer-specific reimbursement methodologies., • Collaborate with Coding leadership to promote accurate CPT, ICD-10-CM, and HCPCS coding, documentation integrity, and compliance with national and payer-specific billing requirements., • Monitor revenue cycle performance through regular analysis of key metrics including, • Days in Accounts Receivable, • Net Collection Rate, • First Pass Claim Acceptance Rate, • Denial Rate, • Bad Debt, • Charge Lag, • Payment Variance, • Develop action plans to improve financial performance and operational efficiency based on data analysis and industry benchmarks., • Partner with physicians, team managers, and operational leadership to resolve reimbursement issues, educate providers on documentation opportunities, and improve charge capture processes., • Maintain current knowledge of Medicare, Medicaid, commercial insurance, workers' compensation, no-fault, and value-based reimbursement models., • Oversee payer enrollment, provider credentialing support, contract implementation, reimbursement analysis, and payer issue resolution., • Ensure compliance with all federal, state, and regulatory requirements including HIPAA, CMS guidelines, OIG recommendations, and payer policies., • Lead revenue cycle optimization initiatives, workflow redesign, technology implementations, and system enhancements., • Develop, implement, and maintain departmental policies, procedures, and internal controls., • Prepare executive-level reports and presentations summarizing financial performance, operational metrics, reimbursement trends, and departmental initiatives., • Recruit, mentor, coach, and develop billing leadership and staff while fostering a culture of accountability, collaboration, customer service, and continuous improvement., • Manage departmental budgets, staffing plans, productivity expectations, and vendor relationships., • Collaborate with Finance regarding month-end reconciliation, revenue reporting, and reimbursement forecasting., • Serve as the organization's subject matter expert on physician billing and reimbursement matters. Qualifications Education • Bachelor’s degree required., • Master's degree preferred., • Professional certifications such as Certified Professional Biller (CPB), Certified Professional Coder (CPC), Certified Revenue Cycle Representative (CRCR), or other revenue cycle certification preferred. Experience • Minimum of 7–10 years of progressive physician billing and revenue cycle management experience., • Minimum of 5 years of leadership experience overseeing physician billing teams., • Strong preference for experience within an orthopaedic or surgical physician practice, academic medical group, or large multi-specialty physician organization., • Demonstrated success improving revenue cycle performance through operational leadership and process improvement., • Experience managing billing operations across multiple clinic locations preferred. Knowledge, Skills, and Abilities • Extensive knowledge of physician billing, reimbursement methodologies, revenue cycle management, and healthcare financial operations., • Advanced knowledge of orthopaedic surgery billing, global surgical periods, modifier usage, surgical coding concepts, musculoskeletal procedural reimbursement, imaging, physical therapy, DME, and ancillary service billing., • Thorough understanding of Medicare, Medicaid, commercial insurance, workers' compensation, no-fault, and payer contract requirements., • Strong knowledge of CPT, ICD-10-CM, HCPCS Level II, National Correct Coding Initiative (NCCI) edits, and documentation guidelines., • Experience with electronic medical records (EMR), physician practice management systems, clearinghouses, and revenue cycle software., • Experience with EPIC is preferred., • Exceptional analytical, financial, organizational, and project management skills., • Strong leadership, communication, and relationship-building abilities with physicians, executives, and multidisciplinary teams., • Ability to interpret financial and operational data to drive strategic decision-making., • Demonstrated ability to lead change, improve workflows, and foster a high-performing team environment., • Advanced proficiency in Microsoft Excel and other Microsoft Office applications. Physical Requirements • Prolonged periods of sitting and computer work., • Ability to occasionally stand, walk, bend, and lift up to 20 pounds., • Ability to travel between UBMD Orthopaedics & Sports Medicine locations as needed., • Work in office 90% of the time Why Join UBMD Orthopaedics & Sports Medicine? As the largest orthopaedic practice in Western New York, UBMD Orthopaedics & Sports Medicine is committed to delivering exceptional patient care through innovation, collaboration, and clinical excellence. The Director of Billing & Revenue is a key member of our leadership team, helping shape the organization's financial health while supporting physicians and staff in delivering outstanding care to our patients.
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