Director of Revenue Cycle Management

Description

The Director of Revenue Cycle provides strategic leadership and operational oversight of William Newton Hospital’s (WNH) entire revenue cycle function, including patient access, billing, coding, claims, denials management, accounts receivable, and payer relations. This position is responsible for achieving revenue goals established through WNH’s organizational planning and goal-setting processes, as approved by the CFO. The Director develops and implements strategies to maximize third-party revenue, improve collections, reduce denials, and ensure compliance across all payer types, including Medicaid, Medicare, commercial insurance, and VA, etc.

The Director reports to the Chief Financial Officer. This position builds and leads a sustainable team structure with sufficient cross-training and depth to ensure continuity of operations.

William Newton Hospital’s Standards of Behavior allow a mechanism for holding each employee accountable and encourages us to "raise the bar".All employees are expected to familiarize themselves with the Standards and practice them daily.

• i
  - Integrity

We act with unwavering moral principle,

transparency, and sincerity in every

interaction.

• P
  - Patient-Centered

We meet patients where they are, ensuring

the are active participants in their care

journey. We prioritize the patient's physical

and emotional well-being over all else.

• A
  - Accountability

We own our actions. We set clear

expectations and hold all team members to

the same high standards.

• C
  - Compassion

We treat every patient, family member, and

colleague with kindness, empathy, and

dignity.

• E
  - Excellence

We approach every task, large or small, with

enthusiasm. We continually pursue mastery

and best practices in our field.

• Develop and execute revenue cycle strategies aligned with organizational revenue goals approved by the CFO, working collaboratively with the executive leadership to achieve financial targets.
• Monitor payer mix trends, identify shifts impacting revenue, and implement corrective strategies to protect and grow high-value reimbursement streams, including ensuring patients are enrolled in available coverage programs.
• Develop revenue models, billing workflows, and staffing plans for new and expanding service lines prior to launch, ensuring billable services are operationally supported before patient volume scales.
• Oversee end-to-end revenue cycle performance across all billing platforms and service lines, ensuring timely claim submission, accurate coding, and maximum reimbursement.
• Recommend and propose revenue cycle investments, technology enhancements, and staffing adjustments to the CFO and CEO for approval, including budget justification aligned with projected revenue impact.

• Provide strategic oversight of the denial management function, including review of trending data, root cause analysis, and systemic interventions to reduce denial rates and improve recovery.
• Establish and enforce AR aging thresholds, write-off policies, and escalation protocols; develop and maintain KPI policy frameworks defining targets if such policies do not yet exist.
• Monitor net collection rates, days in AR, clean claim rate, and other key performance indicators by payer and service line; present performance reports and variance analysis to the CFO and executive leadership.

• Provide oversight and standards for patient access functions, including registration accuracy, insurance verification, eligibility confirmation, prior authorization, and point-of-service collections.
• Ensure consistent patient access standards across all service lines and locations,…