Revenue Cycle Director

• Lead the end-to-end revenue cycle, including registration and eligibility controls, charge capture, coding, claim creation, billing, payment posting, denial management, accounts receivable follow-up, refunds, bad debt, and patient collections.
• Translate SSO goals into annual revenue cycle priorities, staffing plans, productivity expectations, operating procedures, and measurable performance targets, with processes designed to support potential future multi-group growth.
• Identify revenue leakage, reimbursement opportunities, workflow gaps, and root causes affecting cash flow; develop corrective action plans and hold team accountable for results.
• Serve as the subject-matter expert on reimbursement, payer behavior, coding and billing operations, and revenue cycle risk.
• Evaluate internal and outsourced revenue cycle functions and recommend the most effective structure, technology, staffing, and vendor support.

• Ensure complete, accurate, and timely charge capture for office visits, procedures, surgeries, imaging, physical and occupational therapy, durable medical equipment, injections, and other ancillary services.
• Oversee coding quality, claim edits, modifier use, global surgery rules, medical necessity, prior authorization dependencies, bundling, and documentation-related denials.
• Partner with physicians, advanced practice providers, clinical teams, and coding staff to improve documentation and support compliant reimbursement.
• Monitor payer-specific requirements and reimbursement trends for Medicare, Medicaid/MassHealth, commercial plans, workers’ compensation, motor vehicle, and self-pay accounts.
• Coordinate coding audits and education; ensure identified risks and overpayments are escalated and corrected appropriately.

• Direct insurance and patient accounts receivable activity, with clear ownership by payer, aging category, denial reason, and dollar value.
• Establish a disciplined denial prevention and appeals program that addresses root causes rather than repeatedly reworking the same errors.
• Monitor timely filing, clean-claim performance, underpayments, credit balances, unapplied cash, refund obligations, bad debt, and collection agency performance.
• Ensure patient statements, payment plans, estimates, and collection practices are accurate, consistent, respectful, and compliant with applicable requirements.

• Develop and maintain executive dashboards that provide accurate, actionable visibility into revenue cycle performance.
• Report monthly results, trends, risks, corrective actions, and financial opportunities to executive leadership and other stakeholders.
• Reconcile revenue cycle reports with Finance and support month-end close, cash forecasting, budgeting, audit requests, and financial analysis.
• Use benchmarking and practice-specific data to set targets and evaluate team, payer, site, provider, service-line, and vendor performance.

• Lead, coach, and develop revenue cycle managers, supervisors, coders, billers, payment posters, accounts receivable staff, and other assigned personnel.
• Set clear performance expectations, conduct regular one-on-ones and evaluations, address performance concerns promptly, and develop succession and cross-training plans.
• Establish staffing and productivity standards based on volume, complexity, automation, and organizational priorities.
• Manage billing, coding, collection, payment, analytics, and technology vendors through defined service levels, scorecards, issue escalation, and contract accountability.

• Optimize the practice management, electronic health record, payment, reporting, and related revenue cycle systems; ensure data integrity and effective work-queue design.
• Standardize SSO policies and workflows while building scalable practices that can accommodate potential future expansion into a multi-group structure.
• Maintain current knowledge of CMS, MassHealth, commercial payer, HIPAA, coding, billing, and reimbursement requirements applicable to the practice.
• Collaborate with Compliance, Finance, Operations, IT, clinical leadership, and Human Resources on audits, investigations, training, system changes, and organizational initiatives.
• Lead continuous-improvement initiatives that reduce manual work, increase first-pass resolution, shorten payment cycles, and improve the patient financial experience.

• Net collection rate and cash collections compared with budget and expected reimbursement
• Days in accounts receivable and percentage of A/R over 90 and 120 days
• Clean-claim or first-pass acceptance rate and claim submission lag
• Initial denial rate, avoidable denial rate, appeal success, and denial dollars recovered
• Charge lag, unbilled encounters, and missing-charge resolution
• Coding accuracy, documentation quality, and audit results
• Patient balance collections, credit balance resolution, and bad-debt trends
• Staff productivity, quality, turnover, vacancy, and vendor service-level performance

Required Qualifications

• Bachelor’s degree in healthcare administration, business, finance, accounting, or a related field; significant directly relevant experience may be considered in lieu of a degree.
• At least 5 years of progressive healthcare revenue cycle experience, including at least three years leading a substantial revenue cycle team.
• Demonstrated command of professional billing, coding, denials, payer reimbursement, accounts receivable, patient collections, and revenue cycle analytics.
• Experience working with commercial payers, Medicare, Medicaid/MassHealth, workers’ compensation, and other third-party payers.
• Strong analytical skills and the ability to translate financial and operational data into clear decisions and accountable action plans.
• Proven ability to lead change, develop staff, manage competing priorities, and influence physicians and others across functions.
• Advanced proficiency with Athena or other practice management systems, electronic health records, reporting tools, and Microsoft Excel.

• Revenue cycle leadership experience in a private orthopaedic, musculoskeletal, surgical, or other high-volume specialty physician practice; multi-site or multi-group experience is preferred to support potential future growth.
• Experience with orthopaedic surgery, imaging, therapy, DME, injections, global surgical billing, and workers’ compensation.
• CPC, CPMA, CRCR, CHFP, HFMA, or another relevant coding, compliance, or revenue cycle credential.
• Experience leveraging evolving technology, standardizing workflows, overseeing outsourced billing or coding relationships, and supporting practice integration or scalable revenue cycle operations.

• Financial and operational accountability
• Strategic thinking with hands-on execution
• Clear, candid, and respectful communication
• Data-driven problem solving and sound judgment
• Physician and cross-functional partnership
• Talent development and performance management
• Integrity, confidentiality, and compliance orientation
• Urgency, follow-through, and continuous improvement