Director, Revenue Cycle Management
2 days ago
Fort Collins
Description OCR has been the premier provider of orthopaedic care in Colorado, Wyoming, and Nebraska for 55 years! As we continue to grow, we are looking for individuals who share our values and are looking to contribute to our mission and vision. Are you passionate about patient care, teamwork, and inspiring others? If so, join the specialists in the medicine of motion today! The Director of Revenue Cycle Management (RCM) is responsible for providing operational and strategic leadership over all aspects of the organization’s revenue cycle, ensuring optimal financial performance, compliance and patient satisfaction. This role oversees billing, coding, charge capture, collections, and payer relations while collaborating with clinical and administrative teams to streamline end-to-end revenue processes. The Director also manages payer contracting and reimbursement optimizations, working closely with leadership to evaluate payer performance, negotiate terms, and ensure alignment with financial goals. Essential Duties and Responsibilities The mission of the RCM director will be accomplished by (1) overseeing the operational processes of RCM (2) analysis and communication of RCM functions and performance (3) managing Payer contracting and reimbursement; and (4) providing leadership to RCM team members. The RCM director will establish written initiatives for the business office department. The initiatives will be updated yearly, shared with leadership and the business office team, and used to guide the strategic objectives and decision making of the department. Key Results Area #1: RCM Operations • Lead all day-to-day RCM functions including patient access, charge capture, coding, billing, A/R, collections, denials, and cash posting. Monitor team member work product for accuracy, timeliness and completeness., • Monitor KPIs such as Days in A/R, Clean Claim Rate, Denial Rate, and Net Collection Rate, Cash to Net Revenue Ratio, Aged A/R, Contractual Write-Off Accuracy, Payer Performance Scorecards; implement data driven improvements to maximize revenues., • Implement change as needed to ensure process efficiency and automation where possible., • Ensure compliance with Payer requirements, CMS guidelines, and internal financial policies., • Develop and maintain SOPs to promote standardization and quality in RCM workflows., • Ensures accurate and timely month-end, quarter-end, and year-end close processes., • Acts as a subject matter expert for escalated issues arising with patients and/or insurance carriers. Assists teams in resolving these issues and keeps CEO and CFO apprised of problems requiring policy and/or procedural changes on a global level., • Respond to third party payers, management, staff and patients in day-to-day customer service relations and assist with problem resolution escalating unresolved claims or billing issues as needed to CEO and CFO team., • Collaborate with physicians, clinicians, leadership and finance to align clinical and financial workflows., • Maintain monthly KPI dashboard including benchmarks to assess current revenue cycle performance and present to Executive Team as required., • Development and execution of action plans when a KPI is trending negatively., • Support financial forecasting and annual budget planning with accurate RCM data., • Initiate and lead meetings with CEO and CFO to present analysis and suggested changes to RCM operations to influence and facilitate decision making for improved strategies and tactics., • Organize two (or more as requested) physician and two (or more as requested) therapist coding education seminars each year to help maximize billable charges and ensure compliance with laws, rules and policies., • Develop and manage the coding and documentation audit program to enhance revenue integrity., • Present best practice research and education to staff on items including but not limited to root causes of claims denials, underpayments and proven best practices in denials recovery and improved revenue cycle processes., • Serve as primary liaison with insurance payers for contract negotiations, renewals, and performance reviews., • Investigate and recommend new payer relationships, developing payer proposals including pricing, customer needs assessment and procedural and operational systems., • In collaboration with CEO and CFO, analyze payer reimbursement methodologies, fee schedules, and contract performance, identifying carve outs needed (i.e., implants, multiple procedures, etc.), negotiation of rate increases and ensuring legal language is consistent with OCR and related-entity policies., • Identify underpayments, denial trends, and contracting opportunities to maximize reimbursement., • Maintain and support a culture of ethics, compliance, integrity and revenue collection optimization., • Drive accountability and professional development within the RCM department., • Prepare and plan workload and successfully manage department responsibilities, establish priorities, demonstrate ability to adapt to changing, unusual or difficult situations., • Develop, monitor and communicate performance metrics for team members., • Perform performance reviews regularly providing productive feedback and development of growth plans for team members to improve skills and competencies to empower staff to grow to their full potential., • Coordinates training internally or through external seminars to ensure staff are current on coding, billing and collections regulations and using best-practice methodologies., • Maintain and execute a personal growth plan attending meetings, seminars and/or conferences as needed to maintain a current understanding of the industry. Education and Experience • Bachelor’s degree in Business, Healthcare Administration, Finance or related field is required; Master’s preferred (MBA, MHA)., • Eight or more years’ progressive RCM experience in healthcare; at least 3-5 years in management. Additional education may be substituted for experience., • Proven success in payer contract negotiations and reimbursement optimization., • Strong understanding of orthopedic and ancillary billing, surgical coding, payer contracting, and pre-authorization workflows., • Advanced knowledge of EMR, EHR, and RCM systems (Epic, Athena, or similar)., • The work environment is the typical office environment. The employee must be able to complete their work satisfactorily in an environment where there are significant distractions, including staff, patients, and vendors walking through and conversing, telephones ringing, conversations carrying over, loud noises, and interruptions to answer questions from others., • While performing the duties of this job, the employee is regularly required to sit and use hands to finger, handle, or feel objects, tools, or controls up to 8 hours per day. The employee frequently is required to talk or hear. The employee is occasionally required to stand; walk; reach with hands and arms, and stoop, kneel, crouch, or crawl., • Medical, Dental, & Vision coverage, • Life and AD&D Insurance, • Short- and Long-term disability coverage, • Retirement savings and profit-sharing plan participation, • Employee Assistance Program, • Paid Holidays & Time Off Orthopaedic & Spine Center of the Rockies (OCR) is an Equal Opportunity Employer and prohibits discrimination or harassment of any kind. OCR is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions are based on business needs, job requirements and individual experience and qualifications, without regard to a person's race, color, age, sex, gender identity, gender expression, marital status, sexual orientation, religion, creed, national origin, the presence of any physical or mental disability, or status as a disabled veteran, recently separated veteran, other protected veteran, or Armed Forces service medal veteran, or any other protected status. Applications will be accepted until the position is filled; to receive full consideration, please apply by November 7, 2025 Salary Description $140,000 - $190,000/year, based on experience
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