Director of Revenue Reimbursement

Key Responsibilities: Lead and manage daily revenue cycle operations including billing, coding, claims processing, A/R follow-up, payment posting, and denial management. Drive initiatives focused on improving clean claim rates, reducing denials, and increasing operational efficiency. Analyze workflows and identify opportunities for automation and process improvement across the revenue cycle. Monitor key performance metrics including denial rates, productivity, days in A/R, and claim acceptance rates. Develop and implement policies, procedures, and standardized billing workflows to ensure compliance and accuracy. Collaborate with finance, operations, and internal departments to support system enhancements and process alignment. Lead, mentor, and develop billing and revenue cycle teams while promoting accountability and performance improvement. Ensure compliance with Medicare, commercial payer guidelines, and healthcare billing regulations. Assist with reporting, analytics, and strategic planning related to revenue cycle performance.

Qualifications: 10+ years of healthcare revenue cycle experience required.5+ years of leadership or management experience within billing or revenue cycle operations. Strong understanding of Medicare, commercial insurance, HMO, and PPO billing regulations. Experience with EMR/EHR systems required. Knowledge of denial management, claims adjudication, and billing compliance processes. Strong analytical, leadership, communication, and problem-solving skills. Intermediate to advanced Microsoft Excel and Microsoft Office experience preferred. Bachelor's degree preferred; equivalent combination of education and experience may be considered.

Preferred Experience: Experience with Medicare Advantage claims adjudication. Background leading automation or process improvement initiatives within revenue cycle operations.