Director, Revenue Cycle SBO, Net Revenue

The Director of Revenue Cycle Single Billing Office, Net Revenue is responsible for overseeing and directing all aspects of net revenue management for the health system. This role includes ensuring accurate reimbursement from payors, supporting the denials management process, and holding insurance companies accountable for timely and accurate payment. The Director will work collaboratively with clinical, financial, and managed care teams to optimize revenue capture and ensure compliance with regulatory requirements.

Job Responsibilities
 

• Revenue Integrity
  • Partner with Revenue Integrity to support accurate charge capture, coding, and billing processes. Validate and monitor the accuracy of reimbursement from all payors. Develop and implement policies and procedures to enhance revenue integrity and compliance.
• Insurance Relations and Accountability
  • Establish and maintain strong relationships with insurance companies. Hold payors accountable for contract terms and ensure timely resolution of payment discrepancies. Support negotiations with insurance companies to improve payment terms and resolve issues.
• Data Capture from Claims and Payments
  • Support the accurate and timely capture of data from claims and payment transactions. Monitor claims submission in partnership with Directors of Claims and follow up on any discrepancies or rejections. Implement robust data collection and validation processes to ensure the accuracy of claims and remittance data.
  • Utilize data analytics to monitor adjudication patterns and identify opportunities for process improvements.
  • Monitor the integrity and accuracy of payment posting processes in partnership with Director of Cash Management, including reconciliation of payments to accounts receivable. Develop and maintain systems for tracking and reporting on claim status, payment trends, and denial rates.
  • Collaborate with the IT department to optimize the use of electronic health records (EHR) and revenue cycle management software for data capture and analysis.
  • Stay updated with changes in billing codes, payor requirements, and industry standards to ensure compliance and accuracy in data capture.
  • Oversee underpayment and overpayment strategies.
• Reimbursement Validation
  • Monitor and validate the accuracy of reimbursement from all payors, including government programs and private insurers. Analyze reimbursement trends and identify any discrepancies or underpayments. Implement corrective actions and work with payors to resolve reimbursement issues.
• Compliance and Regulatory Requirements
  • Develop and implement policies and procedures to ensure compliance with federal, state, and local regulations, including HIPAA, Medicare, and Medicaid guidelines. Conduct regular internal audits to ensure adherence to regulatory requirements and identify areas for improvement. Stay informed about changes in healthcare regulations and update policies and procedures accordingly.
• Oversees assigned department or functional area to ensure it is performing effectively, which may include but not limited to, preparing and implementing business strategy to achieve the organization’s goals, ensuring legal compliance, communicating and collaborating with stakeholders, managing employment decisions and contributions of supporting team members, and managing departmental budget and fiscal success.

Minimum Requirements:

• 7 years of progressive experience in healthcare revenue cycle management, to include expertise in developing revenue generating strategies
• 3 years in a leadership role within a hospital setting
• Education - Bachelor’s degree in finance, business administration, healthcare administration, or a related field, or 4 additional years of experience in lieu of degree

Preferred Qualifications:

• Extensive experience in managed care contracting and payor relations, with a focus on fostering strategic partnerships and optimizing reimbursement structures.
• Proven ability to enhance internal workflows and develop methodologies that effectively manage and maximize net revenue.

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 24,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare. 

Inova Health System is an Equal Opportunity/Affirmative Action employer. All qualified applicants will recei