Director of Revenue Cycle / Chief Revenue Officer

About the position

The Director of Revenue Cycle will direct daily operations of the revenue cycle function, including coding, medical billing, payment posting, accounts receivable management, workers' compensation, medical records, and disability management. Focusing on maximizing cash flow, ensuring accurate billing, enhancing patient and provider satisfaction, and strategic oversight of revenue optimization, including negotiation and management of Managed Care Contracts in an orthopedic practice setting.

Responsibilities

• Oversees coding, billing, payment posting, accounts receivable follow-up, denial management, and reimbursement processes.
• Leads and manages onshore and offshore revenue cycle staff, including hiring, training, performance evaluation, and motivation.
• Collaborates closely with the CEO and COO to streamline processes, improve operational efficiency, and deliver exceptional customer service.
• Reports directly to the COO.
• Monitors and ensures departmental KPIs meet or exceed industry standards.
• Provides regular training and education to revenue cycle staff and healthcare providers.
• Identifies and resolves issues impacting the revenue cycle promptly.
• Manages timely and effective denial management and appeals processes.
• Maintains updated knowledge of payer policies, regulatory changes, and ensures compliance across the team.
• Ensures accurate and timely month-end closing processes.
• Conducts periodic internal reviews of claim workflows for continuous improvement and compliance.
• Manages revenue cycle-related projects and initiatives.
• Ensures departmental activities comply with federal, state, and payer regulations, including HIPAA and OSHA standards.
• Coordinates internal and external audits related to billing practices.
• Attends management meetings and implements improvements based on audit outcomes.
• Leads strategic revenue initiatives, including the negotiation and oversight of Managed Care Contracts with payers.
• Analyzes payer contracts regularly to ensure compliance and maximize reimbursement.
• Serves as primary liaison with payer representatives, addressing contract-related issues, and negotiating favorable terms.
• Develops and implements strategies to optimize payer relationships and improve overall revenue.
• Performs other duties as assigned.

Requirements

• Bachelor’s degree in healthcare administration, business, or related field required.
• CPC Certification through AAPC preferred.
• Minimum of 10 years of revenue cycle management experience; at least 7 years of medical billing experience required.
• Experience with EPIC strongly preferred.
• Orthopedic or surgical practice experience preferred.
• Extensive experience in negotiating and managing Managed Care Contracts required.
• Knowledge of Illinois Medicaid Managed Care program and experience with other states' Medicaid programs strongly preferred.
• Flexibility in schedule required; occasional travel as needed.

Nice-to-haves

• In-depth knowledge of billing, coding guidelines, compliance, and regulations.
• Proficient in electronic health records (EHR) and practice management systems.
• Strong understanding of orthopedic terminology and procedures.
• Exceptional organizational, multi-tasking, and analytical skills.
• Excellent communication, leadership, and negotiation abilities.
• Strong data analysis background; proficiency in Excel, pivot tables, and other reporting tools to identify trends and improve revenue cycle performance.
• Ability to review, interpret, and ensure the accuracy of medical documentation.
• Ability to maintain high productivity and accuracy in a fast-paced environment.

Benefits

• Supportive Team – Be part of a compassionate and professional healthcare team that values collaboration.
• Competitive Compensation – Enjoy a strong base salary with opportunities for performance-based bonuses.
• Career Growth – Access pathways for professional development and advancement within our innovative practice.
• Meaningful Impact – Help us revolutionize healthcare by making top-tier orthopedic care accessible to everyone.