Head of Revenue Cycle Management

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

📋 Description

• Design, implement, and continually enhance comprehensive RCM workflows across specialty platforms.

• Define and track key performance indicators such as First Pass Rate, Net Collection Rate, Denial Rate, Days in A/R, Clean Claim Rate, and Prior Authorization approval rates.

• Assess and manage third-party billing vendors, establish service level agreements, and determine strategies for in-sourcing and outsourcing.

• Build and lead an internal RCM team by recruiting, training, and developing billing staff, coders, and Accounts Receivable specialists.

• Report on revenue cycle performance to the Director of Finance and C-Suite, providing actionable recommendations.

• Oversee specialized billing and coding for OBL, Vascular/IR, and Podiatry, including supplies capture, fee splits, and payer requirements.

• Lead negotiations for payer contracts and maintain an organized payer contract library.

• Supervise prior authorization processes, patient eligibility verification, charge posting, payment posting, AR appeals, and complex billing disputes.

• Ensure adherence to HIPAA, CMS Conditions for Coverage, OIG guidelines, Medicare and Medicaid regulations, and commercial payer policies.

• Maintain billing policies, perform internal audits, and monitor legislative changes that impact reimbursement.

• Assess and optimize practice management systems, EHR integrations, clearinghouses, and AI-driven claims adjudication tools.

• Create dashboards and reporting infrastructures, automate billing tasks, and utilize analytics to tackle denials, underpayments, and revenue leakage.

⛳️ Requirements

• Over 7 years of experience in leadership roles within Healthcare Revenue Cycle Management.

• Direct experience with Office-Based Lab (OBL) or Ambulatory Surgery Center (ASC) billing is strongly preferred.

• Extensive knowledge of Podiatry and Vascular/interventional radiology coding and medical necessity criteria.

• Advanced skills in Excel and Business Intelligence tools.

• Capability to articulate the narrative behind the numbers to the executive board.

• Bachelor’s degree in Healthcare Administration, Finance, or a related field.

• An MBA or MHA is advantageous.

• CPC, COC, or CHFP certifications are preferred.

🏝️ Benefits

• Comprehensive health benefits package.

• Opportunities for professional development and growth.

• Competitive salary and performance incentives.

• Flexible work arrangements.