Director of Revenue Cycle Services

SUMMARY:
The Director of Revenue Cycle Services is responsible for the overall strategic leadership and operational management of Preferred Management's network of hospitals revenue cycle functions. This role oversees all areas from patient access to final payment, ensuring accuracy, compliance, and efficiency. The Director drives system-wide performance improvement, leads a high-performing team, and partners with clinical, administrative leaders, and the Home Office team to maximize reimbursement, reduce denials, and support the financial stability of all hospitals in the Preferred Management network.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Provide strategic leadership for all hospitals' revenue cycle functions, including Patient Access, HIM, Charge Capture, Coding, Billing, Denials Management, and Collections.
• Oversee and optimize Meditech system workflows within revenue cycle modules to improve accuracy, efficiency, and reporting.
• Develop, implement, and monitor key performance indicators (KPIs) such as AR days, DNFB, denial rates, clean claim rates, and cash collections.
• Ensure timely and accurate submission of all claims, both governmental and commercial, while minimizing rejections and denials.
• Lead initiatives to reduce denials through improved documentation, coding accuracy, and payer communication.
• Maintain a compliant and accurate Charge Description Master (CDM) and support correct charge capture across all departments.
• Collaborate with clinical leaders to support accurate documentation and alignment with regulatory and compliance requirements.
• Direct the implementation of revenue cycle policies, procedures, and best practices to ensure consistency and operational excellence.
• Partner with Compliance and HIM to ensure adherence to CMS guidelines, HIPAA regulations, and all applicable billing and documentation laws.
• Analyze payer trends, reimbursement issues, and claim disputes to identify root causes and drive corrective action plans.
• Prepare and present regular financial and operational reports to executive leadership, identifying risks, opportunities, and strategic recommendations.
• Oversee vendor relationships, including clearinghouses, collection agencies, consulting partners, and revenue cycle technology providers.
• Lead, mentor, and evaluate revenue cycle leadership and staff, fostering a culture of accountability, teamwork, and high performance.
• Coordinate training programs to ensure staff competency in Meditech workflows, billing rules, compliance requirements, and revenue cycle processes.
• Support month-end closing by ensuring timely charge posting, reconciliation, cash balancing, and reporting accuracy.
• Conduct audits of revenue cycle processes to identify errors, inconsistencies, and opportunities for improvement.
• Work with IT and Meditech teams to enhance reporting tools, automate processes, and improve system capabilities.
• Serve as the primary escalation point for complex billing, payer, or patient financial issues requiring senior-level intervention.
• Lead cross-departmental projects aimed at improving the financial health of the organization and optimizing revenue capture.
• Stay current on changes in healthcare regulations, payer guidelines, coding updates, and industry best practices.
• Overnight travel to Preferred Management hospitals to assist with training, workflow processes, compliance, and reimbursement.

SUPERVISORY RESPONSIBILITIES

• Directly supervise revenue cycle leadership and management staff, including hiring, training, coaching, and performance evaluation.
• Provide mentorship and professional development opportunities for staff to enhance team performance.
• Establish clear goals, expectations, and performance metrics for all revenue cycle departments.
• Promote a culture of accountability, teamwork, and continuous improvement.
• Manage workflow assignments, staffing schedules, and department resources to meet operational objectives.
• Conduct disciplinary actions when necessary, in compliance with hospital policies and regulations.

Requirements

QUALIFICATIONS:

• Extensive knowledge of hospital revenue cycle operations, including patient access, insurance verification, coding, billing, charge capture, denials management, and collections.
• In-depth understanding of Meditech Expanse and Business & Clinical Analytics (BCA) revenue cycle modules, workflows, reporting functions, system optimization, and data extraction.
• Strong knowledge of Charge Description Master (CDM), ICD-10, CPT, and HCPCS coding guidelines and how they impact reimbursement.
• Comprehensive understanding of payer rules and reimbursement methodologies, including Medicare, Medicaid, commercial payers, managed care plans, and value-based arrangements.
• Knowledge of federal and state healthcare regulations, including CMS billing guidelines, HIPAA, EMTALA, and compliance standards involved in revenue cycle operations.
• Familiarity with charge capture processes, including documentation requirements and regulatory billing compliance.
• Strong understanding of clinical…