Job Posting
Revenue Cycle Director - Revenue Cycle
Purpose: The Director of Revenue Cycle is accountable for the financial and operational performance of Salem Memorial District Hospital's revenue cycle from patient access through final account resolution. The Director is responsible for ensuring services are accurately documented, charged, coded, billed, collected, and reported in accordance with applicable payer, regulatory, and hospital requirements.
The Director is expected to produce measurable improvement in cash collections, accounts receivable, clean claim performance, denial prevention and recovery, billing timeliness, revenue integrity, and patient financial experience. The Director establishes performance standards, identifies root causes of revenue leakage and payment delays, and holds internal staff and external revenue cycle partners accountable for corrective action and results.
Reporting to the Chief Financial Officer, the Director works closely with clinical departments, providers, nursing, registration, health information management/coding, Finance, Information Technology, Compliance, and external revenue cycle partners. This is a hands-on leadership role requiring the ability to move from executive-level performance reporting to detailed account, claim, payer, workflow, and system analysis when needed.
Key Responsibilities
Revenue Cycle Leadership and Accountability
• Direct and monitor the end-to-end revenue cycle, including scheduling and patient access, registration, insurance verification, authorization, charge capture, coding/HIM coordination, claim submission, payment posting, denial management, accounts receivable follow-up, patient financial services, and final account resolution.
• Establish clear ownership, productivity expectations, quality standards, work queues, escalation pathways, and follow-up requirements for revenue cycle functions
• Maintain current revenue cycle policies and procedures and ensure consistent execution across hospital and clinic operations.
• Coordinate internal staff and external vendors so responsibilities are clearly defined and work does not fall between departments or organizations.
• Serve as the primary revenue cycle escalation point for the CFO and hospital leadership and communicate material cash, billing, compliance, payer, or operational risks promptly.
Patient Access, Charge Capture, Coding, and Billing
• Promote accurate registration, insurance verification, authorization, medical necessity screening, and collection of patient information and applicable patient responsibility at the point of service.
• Monitor charge capture and late-charge processes and work with clinical departments to correct recurring charge, documentation, or workflow issues
• Monitor uncoded, coding-pending, provider-incomplete, and ready-to-bill accounts and ensure barriers are assigned, escalated, and resolved timely.
• Ensure claims are submitted accurately and timely and that edits, rejected claims, billing holds, and claim-status exceptions are actively worked.
• Coordinate with coding/HIM resources to address documentation, coding, modifier, medical necessity, and claim-integrity issues.
Accounts Receivable, Denials, Underpayments, and Cash
• Manage accounts receivable by payer, age, balance, and responsible work team, with focused attention on aged Medicare, Medicare Advantage, Medicaid, commercial, and patient balances.
• Establish denial tracking by payer, denial reason, claim count, and dollars; identify preventable trends and implement corrective action to reduce recurrence.
• Monitor denial appeals and recovery, payer underpayments, credit balances, refunds, unapplied cash, and payment-posting accuracy.
• Develop focused work plans for high-dollar and aged accounts and identify timely filing exposure before claims become uncollectible.
• Monitor cash collections against expected reimbursement, budget, and historical trends; investigate material variances and communicate causes and corrective actions.
• Maintain working knowledge of major payer reimbursement methodologies and contract terms and collaborate with Finance to identify underpayments, incorrect reimbursement, payer-processing issues, and opportunities for reimbursement improvement.
Critical Access Hospital and Rural Health Clinic Revenue Integrity
• Maintain working knowledge of Critical Access Hospital and Rural Health Clinic billing and reimbursement requirements applicable to Salem Memorial District Hospital.
• Coordinate with Finance and cost report resources on revenue cycle matters affecting reimbursement, including Medicare bad debts, settlement support, and documentation required for reimbursement.
• Support appropriate management of informational/shadow claims and other payer-specific billing requirements.
• Partner with clinical and operational leaders to identify revenue leakage, missing or inaccurate charges, documentation deficiencies, and workflow failures that affect reimbursement.
• Monitor observation, inpatient, emergency department, clinic/RHC, laboratory, therapy, ambulance, and other service-line billing workflows for accurate classification and claim submission.
Financial Reconciliation and Finance Support
• Collaborate with Finance to reconcile patient accounting activity, cash posting, contractual adjustments, bad debt, credit balances, refunds, and other revenue cycle activity to the general ledger and financial reporting, as appropriate.
• Investigate and resolve material differences between patient accounting reports, revenue cycle dashboards, cash activity, and financial reporting.
• Provide revenue cycle data and analysis to support net patient service revenue estimates, contractual allowance analysis, cash forecasting, budgeting, month-end and year-end close, audit support, and cost report requirements.
• Ensure Finance receives timely, reliable information regarding significant reimbursement issues, payer trends, aged receivables, denials, and other matters that could materially affect financial results.
Performance Metrics, Analytics, and Corrective Action
• Develop and maintain a revenue cycle dashboard and routinely report results to the CFO and leadership using consistent definitions and reconciled source data.
• Monitor, at a minimum, days in accounts receivable; A/R aging, including balances over 90 and 120 days; clean claim rate; claim rejection rate; initial denial rate by claims and dollars; denial recovery/overturn rate; preventable and timely-filing denials; DNFB/unbilled accounts; coding backlog; ready-to-bill holds; cash collections; net collection rate; credit balances; underpayments; registration/eligibility performance; authorization performance; and point-of-service collections, as applicable.
• Use trend, payer, account, and root-cause analysis to distinguish isolated issues from systemic process failures.
• Develop documented corrective-action plans for material performance deficiencies, including root cause, responsible owner, required action, due date, expected financial or operational impact, and follow-up measurement.
• Report progress on corrective actions until the issue is resolved or an alternative course of action is approved by leadership.
Revenue Cycle Technology and Process Optimization
• Evaluate and optimize the use of revenue cycle technology, work queues, claim-editing tools, analytics, automation, and available system capabilities to improve productivity, claim accuracy, staff efficiency, and cash collections.
• Work with Information Technology, CPSI/TruBridge, clearinghouses, and other vendors to resolve system issues and improve configuration, reporting, interfaces, and workflow.
• Assess whether recurring revenue cycle problems are caused by system configuration, workflow design, training, documentation, payer behavior, or staff performance and implement the appropriate solution.
• Participate in system implementations, upgrades, testing, workflow redesign, and other technology initiatives affecting revenue cycle operations.
Staff Leadership, Productivity, and Development
• Recruit, orient, train, coach, and evaluate revenue cycle staff in coordination with Human Resources.
• Establish and monitor individual and departmental productivity, quality, accuracy, and account-resolution standards.
• Use system reporting and work-queue data to identify workload imbalances, training opportunities, performance deficiencies, and staffing needs.
• Conduct regular team meetings and individual follow-up to communicate priorities, performance expectations, process changes, and identified risks.
• Maintain adequate staffing and cross-training to support continuity of critical revenue cycle functions.
• Develop staff competency in payer rules, system workflows, patient service, compliance, denial prevention, and account follow-up.
• Address performance concerns timely and consistently in accordance with hospital policy.
Compliance, Patient Experience, and Continuous Improvement
• Ensure revenue cycle operations comply with applicable Medicare and Medicaid billing requirements, payer policies, HIPAA, medical necessity requirements, ABN requirements, timely filing requirements, refund and credit-balance requirements, applicable price transparency requirements, and hospital compliance policies.
• Maintain confidentiality and support compliance with CMS Conditions of Participation, applicable Missouri requirements, and the hospital's compliance program.
• Ensure patient financial interactions are respectful, accurate, understandable, and consistent with hospital financial assistance and collection policies.
• Participate in quality and process-improvement initiatives and use structured problem solving to eliminate recurring defects.
• Collaborate across departments to improve documentation, charge capture, billing accuracy, patient communication, reimbursement, and cash realization.
• Perform other duties as assigned by the Chief Financial Officer/Leadership team.
Academic, Certifications, & Trade Qualifications
• Bachelor's degree in healthcare administration, business administration, finance, accounting, health information management, or a related field preferred. Significant directly relevant healthcare revenue cycle experience may be considered in lieu of a degree.
• Five (5) or more years of progressive healthcare revenue cycle experience required, including a minimum of two (2) years in a supervisory, management, or leadership capacity.
• Experience with hospital revenue cycle operations strongly preferred, including patient access, billing, accounts receivable, denials, and reimbursement. Critical Access Hospital (CAH) and/or Rural Health Clinic (RHC) experience is preferred.
• Demonstrated knowledge of hospital and clinic billing, Medicare, Medicare Advantage, Medicaid, commercial insurance, payer reimbursement, claim edits, denials, accounts receivable, payment posting, and patient financial services.
• Working knowledge of CMS requirements, medical necessity, Advance Beneficiary Notices (ABNs), timely filing, payer rules, coding and charge capture concepts, credit balances/refunds, and healthcare compliance.
• Strong analytical skills and proficiency with revenue cycle reporting, spreadsheets, performance dashboards, and root-cause analysis.
• Experience with CPSI/TruBridge or a comparable hospital patient accounting/revenue cycle system preferred.
• HFMA certification, CRCR, CHFP, or other applicable healthcare revenue cycle certification preferred.
Work Experience, Skills, and Strengths
• Accountability and ownership
• Sound judgement and decision-making
• Clear communication
• Collaboration
• Conflict management
• Planning and organization
• Change leadership
• Coaching and mentoring
• Analytical problem solving
• Integrity
• Professional knowledge
• Patient centered service
• Technology adaptability
• Fiscal responsibility
Physical Requirements
• The position requires prolonged computer and telephone use, reading and analysis of detailed financial and clinical information, routine sitting and walking, and occasional lifting or carrying of office materials up to approximately 25 pounds.
• Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Work Conditions
• Work is performed primarily in a hospital, clinic, and office environment with frequent interaction with employees, patients, vendors, payers, and the public
The Ideal Candidate
The ideal candidate is an experienced healthcare revenue cycle leader who combines strong financial and analytical skills with a hands-on, collaborative leadership approach. This individual understands the full revenue cycle—from patient access and registration through billing, collections, denials, accounts receivable, and final account resolution—and is driven to identify opportunities for improvement and turn them into measurable results.
Additional Information
Position Type : Full Time
Shift : Day
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