Director, Revenue Cycle

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership of the complete revenue cycle performance for Upward Health operations.

• Manage the processes of intake, eligibility verification, coding, charge entry, claims submission, accounts receivable follow-up, denial management, payment posting, and collections.

• Set and track revenue cycle key performance indicators (KPIs), including days in accounts receivable (AR), denial rate, first-pass resolution rate, and net collection rate.

• Identify the underlying causes of revenue leakage and implement corrective measures.

• Ensure claims submission and reimbursement are timely and accurate across various payer types.

• Act as the internal expert on Athenahealth practice management and billing workflows.

• Configure and enhance the rules, edits, and reporting in the Athenahealth system.

• Collaborate with IT and operations teams on system enhancements, automations, and integrations.

• Resolve system issues and enhance platform utilization.

• Analyze extensive datasets with advanced Excel skills and create leadership dashboards and reporting tools.

• Convert complex data into actionable insights and improvements while maintaining data integrity.

• Design, document, and standardize Standard Operating Procedures (SOPs) and workflow enhancements for the revenue cycle.

• Implement AI-driven tools, assess technologies and vendors, and spearhead automation pilots and deployments.

• Create a strategic roadmap for AI integration across revenue cycle functions.

• Ensure adherence to payer requirements, CMS guidelines, HIPAA, and other regulatory standards.

• Oversee audits, implement corrective actions, and uphold coding integrity.

• Lead and develop teams in billing, coding, and accounts receivable.

• Set performance expectations, coach team members, and promote accountability and continual improvement.

• Collaborate with clinical, operational, finance, and IT leadership.

⛳️ Requirements

• 7–10+ years of progressive experience in revenue cycle management.

• Direct, hands-on experience with Athenahealth.

• Proficient in advanced Excel skills, including data modeling and reporting automation.

• Strong analytical mindset with a keen attention to detail.

• Proven success in enhancing revenue cycle KPIs and operational efficiency.

• Experience in implementing process improvements and automating workflows.

• Ability to swiftly learn and adapt to new systems.

• Experience in leading teams within a healthcare billing or revenue cycle setting.

• Preferred: experience in value-based care or risk-based contracting environments.

• Preferred: familiarity with EDI transactions (835/837) and clearinghouse operations.

• Preferred: experience utilizing AI or automation tools in healthcare operations.

• Preferred: bachelor’s degree in Healthcare Administration, Finance, or a related field; master’s degree preferred.

🏝️ Benefits

• Benefits information can be found through the linked Upward Health Benefits page; specific benefits are not detailed in this posting.