Director of Billing, Revenue Cycle Optimization

📋 Description

• Manage and integrate billing operations for both Medical Benefit (J-Codes, HCPCS, CPT codes) and Pharmacy Benefit (NCPDP standards).

• Develop and implement "test billing" scenarios to uncover new revenue opportunities.

• Utilize extensive knowledge of U.S. commercial payor policies to effectively navigate complex Prior Authorization requirements.

• Work in conjunction with the Contracting team to ensure that billing practices conform to specific network rates.

• Review and assess current RCM workflows to eliminate inefficiencies.

• Ensure all enhancements remain compliant with OIG, HIPAA, and CMS regulations.

• Establish and report on ambitious RCM metrics, including Days Sales Outstanding.

⛳️ Requirements

• At least 8–10 years of leadership experience in Specialty Pharmacy or Infusion RCM.

• Advanced knowledge in Medical Benefit billing (CMS-1500/UB-04) and Pharmacy Benefit billing (NCPDP).

• Thorough understanding of national and regional commercial insurance reimbursement policies as well as "White Bagging/Brown Bagging" dynamics.

• Expertise in data analytics tools (Excel, PowerBI, or Tableau).

• Bachelor’s degree in finance or healthcare administration, or a related field (Master’s degree or CPC/CPB certification preferred).

🏝️ Benefits

• Performance Bonus (Quarterly/Annual).

• Multi-factor scorecard designed to incentivize operational excellence and financial growth.

• Rewards for reducing Days Sales Outstanding below a specified target.

• Bonuses linked to maintaining the initial denial rate below 5%.