Director RCM - Billing Operations and… at Pediatric… · Plantation

PRIMARY FUNCTION
The Director of Revenue Cycle Management – Billing Operations & Integrations is responsible for leading enterprise-wide billing operations, claim generation, claim quality, edit resolution, clean claim production, acquisition integrations, and revenue cycle operational readiness across the organization. Reporting to the Senior Vice President (SVP) of Revenue Cycle Management, this position provides strategic and operational oversight of centralized billing functions, ensuring claims are submitted accurately, timely, and in compliance with payer requirements while supporting organizational growth through acquisitions, practice onboarding, and technology integrations.

This leader serves as the operational owner of acquisition diligence performance, acquisition integrations and pre-bill revenue cycle performance and is responsible for developing standardized workflows, implementing enterprise billing best practices, and driving automation initiatives that improve claim quality, reduce rework, and accelerate reimbursement. Is responsible for onboarding acquisitions, implementing systems, designing, applying and managing effective billing operations. The Director partners closely with Revenue Integrity, Coding, Patient Access, Information Technology, Managed Care, Finance, and Operational Revenue Cycle leaders to optimize workflows, support system conversions, and establish scalable processes across a centralized business office (CBO) environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES
This list may not include all the duties that may be assigned.
• Lead all enterprise billing operations supporting professional and ambulatory services.
• Oversee pre-bill claim review processes to ensure accurate claim generation and submission.
• Establish enterprise billing standards, workflows, and performance expectations.
• Monitor claim submission performance and billing productivity across all markets and specialties.
• Ensure compliance with payer billing requirements and organizational policies.
• Serve as Revenue Cycle operational lead for acquisitions, mergers, practice onboarding, and integration initiatives.
• Develop and execute revenue cycle integration plans for newly acquired practices and provider groups.
• Coordinate system readiness, workflow design, payer enrollment support, and billing operational transitions.
• Partner with Information Technology, EHR, PM system, and implementation teams to support system upgrades, migrations, and conversions.
• Ensure successful transition of billing operations into enterprise standard workflows.
• Develop post-integration monitoring processes to identify and resolve operational gaps.
• Develop, maintain, and implement enterprise-wide billing and claim management standard operating procedures.
• Partner with other RCM Directors in establishing governance and operational controls supporting centralized business office operations.
• Ensure policies remain current with regulatory, payer, and operational requirements.
• Develop and oversee enterprise billing quality assurance programs.
• Establish quality review methodologies for claim accuracy, edit resolution, and billing compliance.
• Monitor performance through routine audits and quality assessments.
• Identify opportunities for process improvement and staff education.
• Track and report quality performance trends
• Oversee governance and maintenance of billing-related PM system files.
• Collaborate with Information Technology, Coding & RCM teams to ensure accuracy of:
• Payer master files
• Provider records
• Location records
• Billing rules
• Edit configurations
• Claim routing tables
• Implement change management controls to maintain data integrity and operational stability.
• Oversee enterprise claim edit management strategies.
• Develop automated workflows that reduce manual intervention and improve claim quality.
• Analyze billing edits to identify root causes and opportunities for process improvement.
• Partner with Revenue Integrity, Coding, and Patient Access teams to reduce recurring edit volumes.
• Implement automation tools to improve first-pass claim acceptance rates.
• Lead enterprise clearinghouse management and optimization initiatives.
• Ensure efficient claim transmission and monitoring processes.
• Collaborate with vendors and IT teams to implement automation capabilities.
• Reduce manual claim handling and improve electronic claim acceptance.
• Identify opportunities to leverage automation, artificial intelligence, robotic process automation (RPA), and workflow technologies.
• Monitor clearinghouse performance metrics and service-level expectations.
• Monitor rejection trends and implement corrective action plans.
• Coordinate resolution efforts across operational, technical, and clinical teams.
• Minimize claim delays through proactive issue identification and resolution.
• Ensure claims are submitted within organizational and payer-established timeliness requirements.
• Monitor claim lag and billing turnaround times.
• Develop workflows that prioritize rapid resolution of front-end claim issues.
• Ensure root-cause analysis is performed on recurring rejection patterns.
• Manages and gives directions to support training staff when needed during on-site implementation of new processes, technology, systems, and integration.
• Oversees day-to-day change management activities and regularly analyzes measurable performance and KPI’s to ensure positive financial outcomes for the acquired practice(s).
• Reports acquisition’s practice performance to senior management.
• Collaborates with departmental heads to develop financial plans and ensure companywide compliance.
• Evaluates organizational efficiency and makes necessary changes to maximize staff productivity.
• Assists with special projects and reports to ensure maximum payments.
• Other various duties as assigned, including cross training in other functional areas.

SUPERVISORY RESPONSIBILITIES
Manages a team of RCM positions including but not limited to Revenue Operations Manager, Billing Analyst, Billing Assistant, Reimbursement Specialist / Lead, RCM System Administrator, eCW Billing System Administrator. Includes evaluating and completing annual evaluations, hiring, and training.

QUALIFICATIONS

EDUCATION:
• Minimum bachelor’s degree or equivalent experience required.
• Master’s Degree preferred.
LICENSURE
• None

EXPERIENCE:
• Minimum 8–10 years of progressive healthcare revenue cycle leadership experience.
• Minimum 5 years leading RCM operations and M&A Activities
• Experience within physician practice management, ambulatory healthcare, MSO, or health system environments.
• Demonstrated success improving RCM performance, denial recovery, and reimbursement outcomes.
• Experience building and managing centralized business office (CBO) operations preferred.
• Skilled at defining problems, collection of data, interpreting billing information.
• Strong leadership and communication skills both written and verbal.

KNOWLEDGE, SKILLS AND ABILITIES
• Experienced leadership and expertise in direct management of business operations.
• Knowledge of and experience in developing workflow plans with subsequent training, implementation, and performance analysis as it relates to corporate goals.
• Excellent communicator and team leader influencing peers and employees effectively in order to achieve stated goals.
• Communicate clearly and concisely.
• Performance driven and accountable to establish team and individual goals, monitor and report to senior management.
• The ability to represent the Company both internally and externally in order to forward organizational goals and initiatives.
• Skilled with interpreting business analytics as well as developing regular reporting for staff, peers, and senior management.
• Computer literate in Word, Excel, and PowerPoint.

TYPICAL WORKING CONDITIONS
• Non-patient facing
• May be full time remote/telework.
• Must be U.S. based.
• Office environment:
• Travel will be required between PA locations and acquisition locations.
• Involves high & frequent call volumes.
• Multi-tasking, data entry for extended period of times

OTHER PHYSICAL REQUIREMENTS
• Vision
• Sense of sound
• Sense of touch
• Operate computer
• Manual dexterity; sitting
• Ability to wear Personal Protective Equipment (PPE)