Director, Revenue Cycle Management

Description

OCR has been the premier provider of orthopaedic care in Colorado, Wyoming, and Nebraska for 55 years! As we continue to grow, we are looking for individuals who share our values and are looking to contribute to our mission and vision. Are you passionate about patient care, teamwork, and inspiring others? If so, join the specialists in the medicine of motion today! 

The Director of Revenue Cycle Management (RCM) is responsible for providing operational and strategic leadership over all aspects of the organization’s revenue cycle, ensuring optimal financial performance, compliance and patient satisfaction. This role oversees billing, coding, charge capture, collections, and payer relations while collaborating with clinical and administrative teams to streamline end-to-end revenue processes. 

The Director also manages payer contracting and reimbursement optimizations, working closely with leadership to evaluate payer performance, negotiate terms, and ensure alignment with financial goals.

Essential Duties and Responsibilities

The mission of the RCM director will be accomplished by (1) overseeing the operational processes of RCM (2) analysis and communication of RCM functions and performance (3) managing Payer contracting and reimbursement; and (4) providing leadership to RCM team members. 

The RCM director will establish written initiatives for the business office department. The initiatives will be updated yearly, shared with leadership and the business office team, and used to guide the strategic objectives and decision making of the department. 

Key Results Area #1: RCM Operations

• Lead all day-to-day RCM functions including patient access, charge capture, coding, billing, A/R, collections, denials, and cash posting. Monitor team member work product for accuracy, timeliness and completeness.
• Monitor KPIs such as Days in A/R, Clean Claim Rate, Denial Rate, and Net Collection Rate, Cash to Net Revenue Ratio, Aged A/R, Contractual Write-Off Accuracy, Payer Performance Scorecards; implement data driven improvements to maximize revenues.
• Implement change as needed to ensure process efficiency and automation where possible.
• Ensure compliance with Payer requirements, CMS guidelines, and internal financial policies. 
• Develop and maintain SOPs to promote standardization and quality in RCM workflows. 
• Ensures accurate and timely month-end, quarter-end, and year-end close processes.
• Acts as a subject matter expert for escalated issues arising with patients and/or insurance carriers. Assists teams in resolving these issues and keeps CEO and CFO apprised of problems requiring policy and/or procedural changes on a global level.
• Respond to third party payers, management, staff and patients in day-to-day customer service relations and assist with problem resolution escalating unresolved claims or billing issues as needed to CEO and CFO team. 
• Manages all aspects of workers compensation program. 

Key Results Area #2:  RCM Communication, Analysis and Performance 

• Collaborate with physicians, clinicians, leadership and finance to align clinical and financial workflows.
• Maintain monthly KPI dashboard including benchmarks to assess current revenue cycle performance and present to Executive Team as required.
• Development and execution of action plans when a KPI is trending negatively. 
• Support financial forecasting and annual budget planning with accurate RCM data.
• Initiate and lead meetings with CEO and CFO to present analysis and suggested changes to RCM operations to influence and facilitate decision making for improved strategies and tactics.
• Organize two (or more as requested) physician and two (or more as requested) therapist coding education seminars each year to help maximize billable charges and ensure compliance with laws, rules and policies. 
• Develop and manage the coding and documentation audit program to enhance revenue integrity.
• Present best practice research and education to staff on items including but not limited to root causes of claims denials, underpayments and proven best practices in denials recovery and improved revenue cycle processes. 
• Work closely with decision support to develop reporting and analytics to successfully optimize RCM functions.

Key Result Area #3:  Payer Contracting & Reimbursement 

• Serve as primary liaison with insurance payers for contract negotiations, renewals, and performance reviews.
• Investigate and recommend new payer relationships, developing payer proposals including pricing, customer needs assessment and procedural and operational systems. 
• In collaboration with