Director of Revenue Cycle - Professional Services

Director of Revenue Cycle - Professional Services | Summit Healthcare Mgmt | Nashville, Tennessee

About the Job:

PURPOSE STATEMENT:

Position Summary

The Director-Revenue Cycle Professional Services is responsible for leading and optimizing daily accounts receivable operations across the revenue cycle. This role provides both strategic direction and hands-on operational oversight to accelerate cash collections, reduce aged receivables, minimize avoidable write-offs, and strengthen denial prevention and recovery performance.

The Director partners cross-functionally to resolve payment barriers, improve first-pass resolution, and ensure consistent, high-quality execution of follow-up and denial workflows across all payer classes, including government, commercial, managed care, and self-pay.

Roles and Responsibilities:

ESSENTIAL FUNCTIONS:

Revenue Cycle Operations Leadership

• Lead end-to-end revenue cycle operations including billing, collections, denial management, insurance follow-up, cash posting, reconciliation, and customer service, ensuring accurate and timely workflow execution.
• Maintain direct oversight of daily operations, including claim generation, edits, holds, rebills, corrections, billing release, work queues, aging reports, and escalation pathways.
• Ensure compliance with payer requirements, coding and documentation dependencies, internal policies, and contractual obligations.
• Establish, refine, and enforce standard work, operational policies, internal controls, and escalation protocols while maintaining audit readiness.

Billing, Payments, and Reconciliation Oversight

• Oversee all billing functions to ensure timely, accurate claim submission, clean-claim performance, and reduced billing lag and rejections.
• Direct all payment posting and cash management activities, including electronic remittances, manual posting, adjustments, denials at posting, refunds, and unapplied cash workflows.
• Maintain oversight of reconciliation processes, ensuring alignment between cash, EFT, lockbox, credit card, and manual payments with the general ledger and bank reporting.
• Monitor credit balances, posting variances, and unapplied cash aging, implementing corrective actions and process improvements as needed.
• Partner with Finance and Treasury on reconciliation, month-end close, and audit support, while resolving complex reconciliation issues.

Denial Management & Insurance Follow-Up

• Lead all denial management activities including intake, classification, prioritization, trending, prevention, and appeals.
• Ensure timely and accurate denial resolution and appeal submission within payer filing requirements.
• Oversee insurance follow-up to maximize reimbursement, including resolution of underpayments, rejections, no-response claims, payer correspondence, and credit balance issues.
• Monitor payer performance, identify reimbursement barriers, and drive corrective actions in collaboration with contracting, compliance, and operational teams.
• Maintain visibility into high-risk, high-volume, or high-dollar accounts and intervene to ensure resolution and prevent recurrence.

Customer Service Operations

• Lead patient/customer service functions, ensuring accurate, timely, and professional communication regarding balances, billing inquiries, and account status.
• Monitor and improve service metrics including call quality, service levels, abandonment rates, first-contact resolution, and escalation trends.
• Oversee complaint resolution and service recovery efforts to ensure a positive patient financial experience.
• Develop and refine scripts, workflows, and training to ensure consistency, compliance, and service excellence.

Team Leadership & Workforce Management

• Lead a multi-level team including managers, supervisors, leads, and frontline staff across all revenue cycle functions.
• Provide hands-on leadership through coaching, quality reviews, productivity oversight, and performance management.
• Oversee staffing models, workforce planning, hiring, and onboarding to support operational demands and growth.
• Foster a culture of accountability, urgency, accuracy, ownership, and continuous improvement.
• Ensure teams are trained and aligned with payer requirements, workflows, denial trends, and organizational expectations.

Performance Management & Analytics

• Monitor and analyze operational performance across billing, cash posting, reconciliation, AR, denials, and customer service functions.
• Track and drive improvement in key metrics including claim volume, clean-claim rates, AR aging, denial rates, timely filing, productivity, and collection performance.
• Maintain regular review of dashboards and KPIs, taking proactive corrective actions to address risks and gaps.
• Prepare and present operational summaries, insights, and performance trends to senior leadership.

Cross-Functional Collaboration & Process Improvement

• Partner with Patient Access, HIM, Coding, Utilization Review, Case Management, Finance, Treasury, and clinical teams to resolve barriers impacting reimbursement and operational efficiency.
• Identify systemic issues affecting claim accuracy, denials, and collections, and implement targeted process improvements.
• Lead workflow redesign, automation initiatives, system enhancements, and process standardization efforts.
• Maintain strong frontline engagement to ensure alignment between strategic objectives and daily execution.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

• Bachelor's degree in Healthcare Administration, Business, Finance, or related field preferred; equivalent relevant experience may be considered in lieu of degree.
• Five or more years of progressive healthcare revenue cycle experience required.
• Experience in hospital, behavioral health, acute care, physician revenue cycle, or multi-site healthcare operations preferred.
• Strong knowledge of payer reimbursement, denial management, appeals, claims adjudication, and account resolution workflows.
• Working knowledge of payer rules, timely filing requirements, authorization requirements, and reimbursement regulations.
• Strong analytical, problem-solving, leadership, and communication skills.
• Proficiency with EMR/PMS platforms, clearinghouses, payer portals, and Microsoft Excel.
• Experience in behavioral health, SUD, acute psych, or multi-facility healthcare environments preferred.

LICENSES/DESIGNATIONS/CERTIFICATIONS:

HFMA, CRCR, or similar revenue cycle certification preferred.

WORK LOCATION:

This position is hybrid position of remote and on-site at the Company's headquarters in Franklin, TN.

SUPERVISORY REQUIREMENTS:

Three or more years of physician revenue cycle leadership required.

Why Summit Healthcare Mgmt?Summit Healthcare Mgmt offers a comprehensive benefit plan and a competitive salary commensurate with experience and qualifications. Qualified candidates should apply by submitting a resume. Summit Healthcare Mgmt is an EOE.

Veterans and military spouses are highly encouraged to apply. Summit BHC is dedicated to serving Veterans with specialized programming at our treatment centers across the country. We recognize and value the unique strengths of the military community in supporting our mission to serve those who have served.