Overview
The Director of Revenue Cycle Management & Compliance Officer provides strategic and operational leadership for the organization's revenue cycle, encompassing patient access, insurance verification and authorization, charge capture, claims management, payment posting, accounts receivable, patient collections, payer relations, and related revenue-cycle functions. The Director develops and executes strategies that optimize revenue, improve operational efficiency, strengthen internal controls, and support a compliant and effective patient financial experience.
As the organization's Compliance Officer, the Director oversees the Compliance Program and advises physicians, executive leadership, managers, and staff regarding federal and state healthcare requirements, billing and coding compliance, payer requirements, privacy and operational compliance matters, and organizational risk. This includes education, monitoring, investigations, policy development, and corrective-action activities.
The Director also provides strategic oversight of revenue-cycle technology, system configuration, data and analytics, and related vendor relationships. As a member of the senior leadership team, the Director collaborates closely with physicians and leaders throughout the organization to support financial performance, regulatory compliance, strategic initiatives, and long-term organizational success.
Responsibilities
Revenue Cycle Leadership
- Provides strategic leadership and oversight for the full revenue cycle, from patient access and pre-service activities through final account resolution.
- Directs revenue-cycle functions and leaders responsible for insurance verification and authorization, billing, claims submission and follow-up, payment posting, denial management, accounts receivable, patient balances, refunds, and related business-office activities.
- Monitors revenue-cycle performance through dashboards, system reports, payer trends, and key performance indicators; identifies risks and opportunities and implements corrective strategies.
- Establishes and monitors performance standards for timely, accurate, and compliant billing and collection processes.
- Analyzes denials, payment variances, reimbursement trends, aging, payer behavior, and workflow issues to identify root causes and improve net revenue and cash flow.
- Collaborates with clinical, operational, finance, and executive leaders to resolve issues affecting charge capture, reimbursement, patient access, or revenue.
- Develops, updates, and maintains revenue-cycle policies, procedures, internal controls, and standardized workflows.
- Oversees patient financial policies and collection practices to promote consistency, compliance, appropriate financial controls, and a positive patient experience.
- Provides revenue-cycle education and guidance to physicians, managers, and staff as needed.
Patient Access & Front-End Revenue Cycle
- Provides leadership and oversight for front-end revenue-cycle processes, including referrals, appointment scheduling, registration, insurance verification, authorization/precertification, check-in/check-out, and point-of-service collections.
- Evaluates patient-access workflows and system configuration to improve accuracy, efficiency, patient flow, scheduling effectiveness, and downstream revenue-cycle performance.
- Oversees scheduling standards and system controls that support appropriate appointment utilization and reduce preventable registration and scheduling errors.
- Works with operational and clinical leaders on physician scheduling templates, access initiatives, and processes affecting encounter volume and patient retention.
- Uses reporting and analytics to identify front-end process failures that contribute to denials, delayed reimbursement, uncollected balances, or patient dissatisfaction.
Compliance & Risk Management
- Serves as the organization's Compliance Officer and oversees the development, implementation, and ongoing effectiveness of the Compliance Program.
- Coordinates review and resolution of compliance questions, concerns, investigations, and corrective actions.
- Monitors changes in applicable federal and state laws, regulations, payer requirements, and healthcare compliance guidance; communicates operational impact and updates policies and procedures as appropriate.
- Advises physicians, executive leadership, managers, and staff regarding billing and coding compliance, regulatory requirements, internal controls, and operational risk.
- Coordinates compliance education and training and promotes an organizational culture that supports ethical conduct and appropriate reporting of concerns.
- Reviews and investigates reported compliance concerns, coordinates appropriate documentation and follow-up, and recommends corrective action when indicated.
- Performs or oversees required exclusion screening, including OIG and SAM reviews, and maintains appropriate documentation.
- Coordinates with legal counsel, malpractice/risk-management resources, consultants, and other external experts when specialized guidance is required.
- Participates in audits, payer reviews, regulatory inquiries, and other compliance-related activities and coordinates organizational responses as appropriate.
- Supports HIPAA, privacy, security, and other regulatory compliance activities in collaboration with designated organizational leaders.
Payer Relations, Contracting & Regulatory Programs
- Provides oversight and strategic support for payer enrollment, credentialing, contracting, and network participation activities.
- Reviews payer contracts, reimbursement terms, administrative requirements, and operational implications; participates in contract evaluation and negotiation as appropriate.
- Serves as a senior escalation resource for complex payer issues, reimbursement disputes, authorization concerns, claim-processing problems, and policy interpretation.
- Monitors payer policy and regulatory changes and coordinates implementation of required operational or system changes.
- Oversees or supports submission of Medicare, Medicaid, commercial payer, quality, and other regulatory or incentive-program data as applicable.
Technology, Systems, Data & Analytics
- Provides senior functional leadership for the practice management system and revenue-cycle technology, including system configuration, workflow design, testing, maintenance, and implementation of new functionality.
- Serves as an internal subject-matter expert for NextGen Practice Management and related revenue-cycle applications and coordinates with external support vendors as needed.
- Reviews software releases, regulatory updates, payer changes, and new functionality to determine organizational impact; coordinates testing, education, and implementation.
- Partners with vendors and internal stakeholders to troubleshoot system issues, improve workflows, and implement technology solutions that support organizational goals.
- Develops and maintains dashboards, reports, and analyses for executive leadership and physicians, including financial, operational, revenue-cycle, and compliance performance.
- Ensures data used for management decision-making is appropriately defined, validated, and interpreted.
- Evaluates emerging technology and automation opportunities that may improve efficiency, accuracy, patient access, revenue integrity, or compliance.
Organizational & Strategic Leadership
- Serves as a member of the senior leadership team and contributes to organizational strategy, annual planning, financial performance, and major operational initiatives.
- Collaborates with physicians and leaders across departments to identify and resolve operational barriers and support organizational priorities.
- Leads and participates in cross-functional projects involving revenue cycle, compliance, patient access, technology, payer strategy, and practice operations.
- Establishes clear expectations for assigned leaders and teams; develops staff, evaluates performance, supports succession planning, and promotes accountability and continuous improvement.
- Builds effective relationships with physicians, employees, payers, vendors, consultants, and other external business partners.
- Represents the organization professionally and exercises sound judgment in matters involving confidential, financial, regulatory, and sensitive information.
Requirements:
- Bachelor's degree in business administration, healthcare administration, finance, accounting, or a related field; equivalent combination of education and substantial relevant experience may be considered.
- Ten (10) or more years of progressive healthcare revenue-cycle experience, preferably in a multi-site physician-practice environment.
- Five (5) or more years of leadership/management experience with responsibility for revenue-cycle operations or comparable healthcare business functions.
- Demonstrated knowledge of professional billing, payer requirements, Medicare and Medicaid, commercial insurance, denials and appeals, accounts receivable, patient collections, and front-end revenue-cycle processes.
- Substantial experience with healthcare compliance, internal controls, regulatory requirements, and risk-management principles.
- Demonstrated ability to analyze complex financial and operational data and translate findings into actionable recommendations.
- Strong practice-management system expertise.
- Advanced proficiency with Microsoft Excel and experience developing executive-level reports and dashboards.
Join us in leading our revenue cycle management efforts with energy and precision! Your expertise will be instrumental in ensuring our organization’s financial health while maintaining the highest standards of compliance and service excellence.
Benefits:
- 401(k)
- Dental insurance
- Paid time off
Application Question(s):
- Do you have experience with healthcare revenue cycle?
Education:
Experience:
- Revenue cycle management: 8 years (Required)
Ability to Commute:
- Charlotte, NC 28211 (Required)
Work Location: In person
