Position Summary

The Director of Revenue Cycle Management leads the structure, performance, compliance, and continuous improvement of Caretech’s revenue cycle across all operating locations. This role oversees the full revenue process from service delivery through reimbursement, including billing, accounts receivable, payment posting, authorizations, electronic visit verification, payer compliance, payroll-related controls, reporting, auditing, systems access, and revenue-cycle integration for acquisitions and new markets.

The Director combines strategic leadership with strong operational awareness. The position establishes the people, systems, controls, reporting, and processes needed to protect revenue, maintain compliance, and support scalable growth while ensuring routine transactional work is appropriately delegated to the team.

Essential Responsibilities

Revenue Cycle Leadership

·     Own the revenue-cycle process from completed service through accurate reimbursement.

·     Ensure timely and accurate billing, claims submission, payment posting, reconciliation, and follow-up across Medicaid, waiver, private-pay, Veterans, long-term care insurance, and other applicable payer sources.

·     Monitor rejected and denied claims, timely-filing exposure, unbilled services, credits, refunds, overpayments, adjustments, and write-offs.

·     Establish controls and reporting that identify revenue risk early and prevent avoidable revenue loss.

Accounts Receivable

·     Maintain clear accountability for outstanding receivables through aging review, assigned follow-up, escalation standards, and resolution timelines.

·     Identify high-risk balances, recurring collection barriers, payer trends, and systemic causes of delayed reimbursement.

·     Communicate the organization’s accounts-receivable position, material risks, and recommended actions to executive leadership.

Authorization and EVV Oversight

·     Oversee authorization and electronic visit verification processes that affect reimbursement.

·     Monitor authorization gaps, expiration dates, services delivered outside approved parameters, and EVV exceptions that may delay or prevent billing.

·     Establish correction and escalation workflows and ensure staff understand payer-specific authorization and EVV requirements.

·     Analyze recurring issues and partner with operations to address root causes.

Compliance and Internal Controls

·     Develop, maintain, and enforce standard operating procedures and internal controls for billing, reimbursement, documentation, payroll-related processes, and financial compliance.

·     Conduct internal audits, monitor payer and Medicaid requirements, prepare for external audits, and coordinate responses to audit requests.

·     Identify regulatory and financial risks, implement corrective-action plans, and maintain appropriate separation of duties whenever possible.

Reporting and Executive Communication

·     Provide clear, timely reporting on revenue performance, billing status, accounts receivable, denials, authorization exposure, EVV concerns, payment trends, adjustments, write-offs, payer issues, compliance risks, and team workload.

·     Interpret results, explain material variances and risks, and recommend specific operational or financial actions rather than distributing data without analysis.

·     Develop dashboards, scorecards, and review cadences that make revenue-cycle performance measurable and actionable.

Payroll Related Oversight

·     Oversee payroll controls that intersect with scheduling, EVV, billing, compliance, and finance, including verified hours, reconciliation, mileage, training hours, bonuses, leave, garnishments, retirement deductions, and employment verification.

·     Support multi-state payroll compliance, tax and unemployment registrations, contractor documentation, and applicable offshore contractor compliance documentation.

·     Provide oversight to the Payroll Specialist or other assigned staff, review accuracy, and resolve escalated payroll issues without routinely serving as the primary processor.

Team Leadership

·     Lead billing, payroll-support, revenue-cycle administration, reporting, and auditing functions across operating locations.

·     Define roles, establish priorities, monitor workloads, delegate responsibilities, and provide coaching, training, cross-training, and performance feedback.

·     Establish backup coverage and develop a department that functions effectively without routine matters requiring Director intervention.

·     Evaluate staffing capacity and recommend changes needed to maintain performance and support growth.

Systems and Access Oversight

·     Maintain governance over revenue-cycle, EVV, payroll, accounting, Medicaid, payer, reporting, and auditing platforms, including AxisCare, NetSmart, Authenticare, KMAPS, Mobile Caregiver+, ADP Workforce Now, Ventium, Blue Summit, Bill.com, and other systems used by the organization.

·     Maintain visibility into system purpose, user access, security permissions, backup access, training documentation, critical workflows, and system dependencies.

·     Ensure staff are trained and access is appropriate without becoming the primary user for every system function.

Acquisitions and New Markets

·     Lead revenue-cycle readiness and integration for acquisitions, new locations, and new payer programs.

·     Assess billing, accounts receivable, payer relationships, payroll, authorizations, EVV, systems access, staffing, and compliance risk.

·     Develop transition milestones, coordinate training, protect billing continuity, and prevent interruption in reimbursement.

Leadership and Decision Making

The Director is expected to independently manage routine revenue-cycle decisions, including:

·     Establishing workflows, departmental priorities, team responsibilities, audit processes, and internal controls.

·     Prioritizing revenue-cycle projects and assigning resources.

·     Escalating revenue risk and developing corrective-action plans.

·     Recommending staffing, training, process, and system improvements.

Executive approval is required for matters involving significant financial exposure, organizational policy changes, compensation decisions, major system investments, significant staffing changes, legal or regulatory exposure, or material payer disputes.

Qualifications

·     Bachelor’s degree in business, healthcare administration, finance, accounting, or a related field preferred; equivalent relevant experience may be considered.

·     Five or more years of progressive revenue-cycle, billing, reimbursement, healthcare finance, or related experience, including experience leading people or complex processes.

·     Experience with Medicaid, waiver, EVV, home care, home health, or other multi-payer healthcare services strongly preferred.

·     Demonstrated experience with accounts receivable, denied claims, authorizations, internal controls, audits, and performance reporting.

·     Experience supporting multiple locations, multiple states, acquisitions, or rapid organizational growth preferred.

Knowledge Skills and Abilities

·     Strong understanding of end-to-end revenue-cycle operations and the dependencies among service documentation, scheduling, EVV, payroll, billing, and reimbursement.

·     Ability to translate detailed financial and operational data into clear risks, priorities, and recommendations for executive leadership.

·     Strong leadership, delegation, coaching, and accountability skills.

·     Sound judgment when balancing revenue protection, regulatory requirements, operational realities, and client service.

·     Ability to build scalable workflows, written procedures, controls, dashboards, and audit processes.

·     High degree of accuracy, discretion, follow-through, and comfort working with confidential financial, employee, and client information.

·     Ability to manage competing priorities, resolve escalated problems, and collaborate effectively across operations, finance, payroll, compliance, and executive leadership.

General Expectations

The Director is expected to maintain confidentiality, comply with all applicable organizational policies and payer requirements, model professional and ethical conduct, and perform other related duties reasonably assigned based on business needs. This job description describes the primary responsibilities of the position and is not intended to be an exhaustive list of every duty.