Director, Revenue Cycle Operations

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Job Summary

The Director, Revenue Cycle Operations is responsible for leading and coordinating all revenue cycle activities, ensuring compliance with federal, state, and payer-specific billing requirements. This role involves managing the revenue cycle process, collaboration with other departments, including patient registration functions, coding, except for Medicare Advantage lines of business, billing, collections, and cash posting, to ensure efficient and effective financial operations. This role aims to maximize reimbursement and streamline operational efficiency.

Essential Duties & Responsibilities

• Manages core revenue cycle operations to promote efficiency while decreasing the overall cost to collect.
• Ensure maximization of cash collections through diligent and timely monitoring of all open accounts receivable balances.
• Ensure timely reconciliation of cash collections, cash posting and month end processes.
• Manages vendor engagement, billing, coding, AR, auditing, and revenue cycle functions.
• Establish and maintain all billing and financial data within the electronic medical record.
• Develop and analyze monthly Revenue Production Reports.
• Develop and implement procedures for continual quality improvements in billing to improve the accuracy and timely submittal of all data to process claims according to compliance targets. This will include the development of feedback mechanisms to operations leaders related to front desk and eligibility opportunities, to immediately identify and resolve any inaccuracies in visit coding and other issues.
• Ensure timely processing of claims, denial re-submittal, and accounts receivable management to meet compliance measures.
• Ensures that entity and provider information is current for the following contracts, Medicaid, Medicare, Managed Care programs, third party PPOs, and other contracts necessary to bill for all entity services. Draft appropriate procedures to implement and monitor all organizational policies pertaining to sound front desk and billing practices, AR management, and maximization of revenues.
• Develops and Ensures that Billing/Collection Policies and Procedures are implemented and are always kept current.
• Works extremely well under pressure, meets multiple and often competing deadlines.
• Develops metrics for Days in AR, Denials, Cash Collections, and Staff Productivity.
• Other duties as assigned.

Supervisory Responsibilities

• Lead, coach, and develop a high-performing team including manager. Develop succession plans, training roadmaps, and performance improvement plans. Foster an inclusive, engaged, and mission-driven team culture.
• Guides and mentors’ revenue cycle team members, fostering a collaborative environment that attracts and retains top talent.

Education & Experience

• Bachelor's degree in Business, Finance, Health Administration, or related field required; Master’s degree preferred.
• Minimum 10 years of progressive experience in insurance/healthcare and revenue cycle operations.
• At least 5 years in a leadership role managing cross-functional teams.
• Experience leading a revenue cycle management team with off-shore capabilities.
• Strong analytical and problem-solving skills with high attention to detail.
• Experience working in a fast-paced, dynamic environment with competing priorities.

Education Requirements

Education Level

Discipline

Required

Bachelor's Degree

Business, Finance, Health Administration, or related field required.

Knowledge, Skills & Proficiencies

• Solid understanding of electronic medical record processes (ECW preferred)
• Experience with risk-based contracting and managed care preferred.
• Experience streamlining processes and working with cross-functional teams.
• Deep expertise in revenue cycle management, payer regulations, and reimbursement methodologies.
• Proficient in EMR and billing platforms; advanced Excel and reporting tools experience.

Physical Requirements

This position works under usual office conditions. The associate is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Conditions

Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing.

Travel Requirements

Amount of Expected Travel

Details

Yes

0-25%

Flexibility to travel to clinical sites as needed.

Tools & Equipment Used

Computer and peripherals, standard and customized software applications and tools, and usual office equipment.

Disclaimer

The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

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