Director, Revenue Cycle Management
6 days ago
Paramus
Job Description Pay Transparency: 180K - 200K plus bonus About NexGen Orthopedic Health and Wellness NexGen Orthopedic Health and Wellness was founded with a clear purpose: to improve the quality of life of every patient we serve. We believe orthopedic care should be compassionate, personalized, and holistic — focused not only on treating conditions, but on restoring freedom, mobility, and confidence. As a fully integrated, multi-specialty, multi-site organization spanning orthopedics, interventional pain, wellness, and ambulatory surgery, NexGen delivers care across the full continuum. Our clinical excellence is nationally recognized by leading professional organizations including the Cervical Spine Research Society, American Academy of Orthopaedic Surgeons, Society for the Study of Lumbar Spine, and the North American Spine Society. Already a highly successful provider in the communities we serve, NexGen is now entering its next chapter: intentional scale, enterprise maturity, and durable growth — without compromising the patient-first values that define who we are. Why NexGen Orthopedics This is not a role where you will manage a function from a distance. You will be close to the work, close to the team, and close to the decision-making every single day. NexGen is a fully on-site environment because we believe that proximity matters — to culture, to collaboration, and to the kind of leadership that actually moves people. Reporting directly to the CEO means your insights will land in the right place and your recommendations will be heard. NexGen has built something that matters — high-quality collaborative and holistic orthopedic care delivered with integrity. The revenue cycle is not a back-office function here. It is the financial infrastructure that makes the mission sustainable. If you want to do work that is strategically important, operationally complex, and genuinely impactful, this is the right place. The Opportunity NexGen Orthopedics ‘clinical operations are strong, the patient volume is growing, and the team is fully staffed. What we need now is a revenue cycle leader who can walk into a functioning department and make it extraordinary — not by rebuilding from scratch, but by asking the right questions, challenging inherited assumptions, and creating the conditions for the team to perform at their ceiling. This role reports directly to the CEO, which means you will have real proximity to strategic decision-making, real authority to drive change, and real accountability for outcomes. You will not be handed a playbook. You will be expected to write one — grounded in data, informed by experience, and built with the team, not around them. The right person for this role is equally comfortable confidently advising the C-Suite and getting into a billing queue. You bring deep revenue cycle expertise across orthopedic, physical medicine, and related specialties — with particularly strong command of out-of-network billing, one of the most complex and revenue-critical areas of this practice. You know how to read a situation before you redesign it. You synthesize complex information quickly, push back constructively when something doesn’t add up, and make confident judgment calls when the data is incomplete — because it often will be. One of your earliest priorities will be to diagnose the current billing team with clear eyes — assessing talent, workflows, tools, and culture — and then take decisive action to reset and optimize. The healthcare and insurance landscape is shifting faster than most organizations can track. NexGen needs a leader who will not just keep pace with that change but anticipate it, restructure around it, and position this team to maximize revenue generation in an environment where the rules are constantly being rewritten. What You’ll Own Revenue Cycle Leadership • Oversee all aspects of daily revenue cycle operations — billing, collections, denial management, payment posting, and accounts receivable — with a focus on efficiency, accuracy, and performance., • Develop and execute strategies to hit key metrics including net cash collections, A/R days, unbilled A/R, denial rates, and report progress with clarity and candor to the CEO., • Manage out-of-network revenue recovery, including cases where insurers issue payments directly to patients, and lead the outreach and collection process with both empathy and rigor., • Oversee internal appeals, external appeals, and arbitrations., • Ensure accurate, timely posting of all transactions, including adjustments and write-offs, and investigate discrepancies before they become patterns. Out-of-Network Billing & Revenue Recovery • Lead all aspects of out-of-network billing operations, including claim submission, appeal strategy, payer negotiation, and arbitrations — with deep expertise in navigating the unique complexity and risk of OON workflows., • Manage cases where insurers redirect payments to patients: track, communicate, and recover those funds through a structured, empathetic, and persistent process., • Develop and maintain out of network - specific billing protocols based on Fair Health data that adapt to shifting payer policies and protect NexGen’s reimbursement position in an increasingly aggressive coverage environment., • Identify patterns in OON denials and underpayments and translate those insights into proactive strategy adjustments and payer escalation., • Serve as the in-house subject matter expert on Fair Health data and OON reimbursement — educating the team, advising leadership, and ensuring the practice captures the full revenue it has earned. Team Development & Performance • Conduct a thorough, honest assessment of the current billing team — evaluating talent, workflows, tools, and performance gaps — and develop and execute a plan to reset, restructure, and optimize for revenue generation in a rapidly changing insurance landscape., • Run regular staff meetings that go beyond status updates: use them to sharpen the team’s understanding of reimbursement methodology, payer changes, and compliance requirements., • Identify development opportunities for high-potential staff and create a culture where feedback is direct, timely, and constructive., • Be a visible, present leader every day. At NexGen, culture is not built on Slack or in quarterly all-hands meetings — it is built through daily interactions, informal moments, and the example you set in person. Your on-site presence five days a week is a leadership strategy, not a scheduling requirement., • Balance workload across billing queues and ensure staffing and systems are aligned to departmental goals. Payer Strategy & Compliance • Maintain deep working knowledge of third-party billing rules, and reimbursement practices; serve as the escalation point for complex payer issues and disputes., • Stay current on changes in Fair Health data, commercial payer updates, and industry regulatory changes — and translate those updates into operational adjustments quickly. Analytics & Strategic Insight • Analyze large data sets to generate financial insight — not just reports. Regularly present trends, anomalies, and recommended action plans to leadership in a format that drives decisions., • Build and maintain departmental dashboards that surface the metrics that matter, in real time., • Conduct independent remittance analyses with meticulous attention to detail, including tracking check numbers, mailing timelines, and reissue statuses for complex payment cycles., • Evaluate payer reimbursement changes and policies to provide leadership with an honest, informed view of payer performance and risk. Operations & Systems • Review and update policies, procedures, and electronic claims formatting to reflect current standards and payer requirements., • Evaluate systems and workflows continuously; recommend and implement improvements when the evidence supports it., • Oversee the distribution of A/R and denial reports to staff and ensure dashboards are maintained and actionable. What We’re Looking For Beyond the technical qualifications, we are looking for a specific kind of thinker and operator. Someone who leads with questions before conclusions, who can hold complexity without collapsing it into oversimplification, and who earns trust through the quality of their judgment, not just the length of their experience. Required Experience • 7+ years in healthcare revenue cycle management, with at least 3 in a director-level role with direct accountability for performance outcomes., • Demonstrated expertise in out-of-network billing workflows — this is a non-negotiable. You understand Fair Health, OON claim submission, appeals, payer tactics, and patient-directed payment recovery at a deep, hands-on level., • Specialized knowledge in Orthopedic, Pain management, and patient account management. Exposure to Conservative Therapy (physical, occupational, chiropractic), Physical Medicine and Rehabilitation and vascular services strongly preferred., • In-depth knowledge of Fair Health data, third-party billing rules, payer contracts, reimbursement practices and motor vehicle claims., • Strong track record of resolving denied and underpaid claims through consistent follow-up and effective payer advocacy., • Proficiency with data tools including Excel and Google Sheets; comfort pulling and building your own reports without waiting for an analyst., • Familiarity with payer portals, major commercial insurance carriers, and claim submission processes including coordination with attorneys where applicable. What Sets You Apart • You ask the right questions before you run an analysis. You understand that bad inputs produce confident-looking wrong answers, and you don’t accept the framing of a problem at face value., • You push back on assumptions — respectfully, with evidence — and you’re comfortable being the person in the room who says “The data shows something different.”, • You synthesize information quickly across billing, operations, clinical, and finance, and make sound judgment calls even when the picture is incomplete., • You are equally strategic and operational. You can architect a multi-quarter revenue cycle vision and still get into the details of a remittance discrepancy when the moment calls for it. Leaders who only operate at altitude are not the right fit here., • You can present to the CEO and coach a billing coordinator in the same week, and both will feel like they got what they needed. Both of these tasks are within the scope of your role., • You have a measurable track record: improved net collection rates, reduced denial rates, A/R days moved. You can point to the numbers., • You have diagnosed and reset an underperforming or misaligned billing team before — you know what to look for, how to have the hard conversations, and how to rebuild momentum without losing continuity of operations., • You understand that the healthcare reimbursement landscape is not static. You stay ahead of payer policy changes, regulatory shifts, and industry trends — and you know how to reorganize a team and its workflows to stay one step ahead rather than one step behind., • Certified Professional Coder (CPC) or equivalent certification is a plus. Company DescriptionWHO WE ARE NexGen Orthopedic Health and Wellness was founded with a clear purpose: to improve the quality of life of every patient we serve. We believe orthopedic care should be compassionate, personalized, and holistic — focused not only on treating conditions, but on restoring freedom, mobility, and confidence. As a fully integrated, multi-specialty, multi-site organization spanning orthopedics, interventional pain, wellness, and ambulatory surgery, NexGen delivers care across the full continuum. Our clinical excellence is nationally recognized by leading professional organizations including the Cervical Spine Research Society, American Academy of Orthopaedic Surgeons, Society for the Study of Lumbar Spine, and the North American Spine Society. Already a highly successful provider in the communities we serve, NexGen is now entering its next chapter: intentional scale, enterprise maturity, and durable growth — without compromising the patient-first values that define who we are.WHO WE ARE\r\nNexGen Orthopedic Health and Wellness was founded with a clear purpose: to improve the quality of life of every patient we serve. We believe orthopedic care should be compassionate, personalized, and holistic — focused not only on treating conditions, but on restoring freedom, mobility, and confidence.\r\n\r\nAs a fully integrated, multi-specialty, multi-site organization spanning orthopedics, interventional pain, wellness, and ambulatory surgery, NexGen delivers care across the full continuum. \r\n\r\nOur clinical excellence is nationally recognized by leading professional organizations including the Cervical Spine Research Society, American Academy of Orthopaedic Surgeons, Society for the Study of Lumbar Spine, and the North American Spine Society.\r\n\r\nAlready a highly successful provider in the communities we serve, NexGen is now entering its next chapter: intentional scale, enterprise maturity, and durable growth — without compromising the patient-first values that define who we are.
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