Director of Revenue Cycle Management
hace 13 días
Syracuse
Job Description GENERAL DESCRIPTION The Director, Revenue Cycle Management (RCM) is responsible for driving day-to-day operational performance across Evolve Orthopedic Partners’ MSO revenue cycle functions with a primary focus on outsourced vendor oversight for Accounts Receivable (AR), payment posting, and reconciliation. Reporting to the VP, RCM, this role ensures vendor-delivered work is accurate, timely, compliant, and aligned to enterprise policies, payer rules, and platform KPIs. The Director partners closely with Practice Operations, Finance/Treasury, IT, Compliance, and clinical/administrative leaders to optimize cash, reduce aged AR, improve denial and underpayment outcomes, and strengthen controls across multiple practices and surgery centers. RESPONSIBILITIES Vendor Management & Performance (AR, Payment Posting, Reconciliation) • Own operational oversight of multiple outsourced RCM vendors supporting AR follow-up, denial/underpayment work queues, payment posting, and remittance reconciliation across the platform., • Translate enterprise goals into clear vendor expectations, work standards, productivity requirements, and service levels; ensure adequate staffing, coverage, and contingency planning., • Establish and run recurring vendor operating rhythms (daily/weekly huddles, monthly QBRs), including KPI reviews, root-cause analysis, and corrective action plans., • Monitor vendor quality through audits and controls (posting accuracy, contractual allowance mapping, denial code accuracy, adjustment integrity, refund processing, reconciliation completeness)., • Ensure vendors comply with Evolve policies, payer rules, HIPAA/security requirements, and documentation standards; escalate and resolve issues quickly., • Partner with Finance/Treasury and vendor teams to ensure cash application integrity, bank deposit/lockbox alignment, ERA/EFT enrollments, and timely reconciliation of exceptions., • Support contract administration by reviewing vendor invoices against deliverables, validating performance, and recommending optimizations or scope changes to maximize value. AR Strategy, Denials Management & Cash Acceleration • Drive consistent AR work standards across practices (aging prioritization, escalation pathways, payer strategy playbooks, timely filing safeguards, appeal processes)., • Oversee denial and underpayment management, including identification of trends, root causes, and cross-functional fixes with Coding, Charge Entry, Patient Access, and Operations., • Ensure appropriate handling of credit balances, refunds, recoupments, and patient overpayments; maintain controls that protect against write-off leakage and compliance risk., • Partner with leadership to set targets for aging buckets (30/60/90+), denials rates, and cash velocity; develop and execute action plans to achieve targets., • Support payer issue escalation and complex claim resolution, including high-dollar accounts, out-of-network scenarios, retro-authorizations, and post-payment audits. Payment Posting, Reconciliation & Controls • Ensure accurate and timely posting of ERAs/EOBs, including payments, adjustments, contractuals, takebacks, interest, and patient responsibility., • Lead reconciliation processes that ensure posted activity matches payer remits, bank deposits, lockbox files, and merchant services reports; investigate and resolve variances., • Partner with IT/PM teams to maintain payer mappings, posting rules, and reconciliation workflows; ensure changes are tested and validated prior to release., • Develop and maintain audit trails and control documentation that supports internal and external audits., • Oversee refund workflow controls, including payer vs patient refunds, approvals, and reconciliation to GL as applicable. Reporting, Analytics & Continuous Improvement • Own operational reporting cadence for assigned functions; validate data integrity and ensure stakeholders receive accurate, actionable KPI reporting., • Build and maintain dashboards for vendor KPIs and revenue cycle performance (cash posted, cash collected, denial trends, AR aging, reconciliation exception queues, turnaround times)., • Identify system/process defects and drive fixes with cross-functional partners; create standard work, SOPs, and training materials as processes evolve., • Support integrations, acquisitions, and practice conversions by partnering on workflow design, vendor onboarding, and go-live stabilization plans. Leadership & Collaboration • Serve as a key RCM leader for the MSO, modeling accountability, urgency, and a service mindset across practices., • Coordinate with Patient Access, Coding, Charge Entry, Clinical Operations, and Finance to ensure clean claim flow and timely resolution of issues impacting cash., • Escalate risks and opportunities to the VP, RCM with clear analysis, recommendations, and expected impact., • Lead special projects and ad hoc analyses as assigned, including payer initiatives, workflow redesign, and performance improvement sprints. QUALIFICATIONS Education: • Bachelor’s degree in healthcare administration, Business, Finance, or related field required (or equivalent combination of education and experience)., • Certification such as CPC, CPB, CRCR, CHFP, or equivalent, preferred. Experience: • 7+ years of progressive revenue cycle experience in physician practice management, MSO, or multi-site medical group environment; orthopedic and/or surgical (ASC) experience strongly preferred., • 3+ years of leadership experience with direct accountability for AR performance and/or payment posting and reconciliation., • Demonstrated experience managing outsourced RCM vendors (setting expectations, monitoring SLAs, conducting audits, leading QBRs, and improving performance)., • Working knowledge of payer remittances (ERA/EOB), EFT/lockbox processes, adjustments, denials, appeals, refunds, and reconciliation best practices., • Experience with practice management and billing systems; ability to partner with IT on mappings, rules, and workflow optimization., • Experience with automation/outsourced workflows (RPA, work queue automation, clearinghouse tools) and process redesign, preferred., • Experience supporting acquisitions/integrations and standardizing revenue cycle processes across multiple entities, preferred. Performance Requirements: • Strong vendor management, negotiation, and influence skills, with the ability to drive outcomes through others in a matrixed environment., • Analytical and detail-oriented; able to identify root causes, quantify impact, and prioritize high-return work., • Operational excellence mindset; able to build standard work, controls, and scalable processes., • Excellent written and verbal communication skills; able to communicate with frontline teams, executives, and external partners., • High integrity and sound judgment; maintains confidentiality and ensures compliance with policies and regulations., • Proficiency with Microsoft Excel and reporting tools; comfort working with KPIs and dashboards., • Ability to manage multiple priorities in a fast-paced healthcare environment, • Travel as needed to other locations for training and to perform job functions. PHYSICAL REQUIREMENTS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. This role primarily requires the ability to remain in a stationary position for extended periods, operate a computer and standard office equipment, and perform repetitive movements such as typing and using a mouse. The position may also require occasional standing, walking, and lifting or moving items up to 10–15 pounds. This position operates in a professional office environment; hybrid or remote work arrangements may be available based on business needs. Periodic travel to practice locations, ambulatory surgery centers (ASCs), and/or vendor sites may be required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
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