Director of Revenue Reimbursement

The Director of Revenue Cycle is responsible for leading and optimizing all revenue cycle operations with a strong focus on front-end accuracy, automation, and clean claim submission. This role drives system and process improvements to reduce denials, minimize rework, and improve overall financial performance.

In addition, you will be responsible for contributing to the growth and success of HealthTexas while upholding our Mission, Vision and Values.

Culture and Values Expectations

At HealthTexas, we believe that our workplace culture is the cornerstone of our success. We are committed to fostering an inclusive, collaborative, and innovative environment where every Associate feels valued, empowered and motivated to reach their full potential. Our culture is the driving force behind our mission "to deliver quality and compassionate care with outstanding service, every patient, every time". As a (Job Title) at HealthTexas we expect you to embody and promote our Values and defined behavioral expectations.

• Integrity: Do the right thing, the right way, every time.

• Be honest and uphold commitments and responsibilities, earn the trust and respect of the team and those we serve, and maintain privacy and confidentiality.

• Compassion: Treat everyone with respect and dignity.

• Foster an environment of inclusivity and well-being, practice patience and empathy, and assume positive intent.

• Synergy: Collaborate to improve outcomes.

• Invite and explore new opportunities, promote effective communication and teamwork, take pride in yourself, your work and HealthTexas.

• Stewardship: Use resources responsibly and efficiently.

• Implement effective strategies to attain goals, achieve maximum productivity and results, and seek continuous knowledge and improvement.

Essential Job Duties & Responsibilities

• Lead the strategy and execution of revenue cycle operations, with emphasis on improving first-pass claim acceptance and reducing downstream rework.

• Drive automation and system optimization initiatives, prioritizing front-end process improvements that prevent denials before they occur.

• Evaluate current workflows and proactively identify opportunities to enhance auto-submission processes and overall efficiency.

• Collaborate closely with the VP of Finance to align on priorities, validate proposed process or system changes, and communicate improvement plans prior to implementation.

• Ensure proposed solutions are practical within current system capabilities and informed by past lessons learned.

• Monitor and report on key performance indicators, including denial rates, clean claim rates, days in A/R, and productivity metrics.

• Interpret metrics effectively and translate insights into action.

• Identify root causes, implement process improvements, and develop staff through targeted training and coaching to achieve performance and productivity expectations.

• Lead, develop, and hold teams accountable for performance across all revenue cycle functions, including charge entry, coding, billing, A/R follow-up, and payment posting.

• Develop and maintain policies, procedures, and standardized workflows that support accuracy, compliance, and efficiency.

• Partner with internal departments to support system enhancements, data integrity, and workflow alignment.

• Ensure compliance with all regulatory requirements, including Medicare and other governmental payers.

• Continuously assess industry best practices and implement improvements that align with organizational goals.

Leadership Expectations

• Promote a proactive, solutions-oriented culture focused on prevention rather than rework.
• Communicate clearly, escalate risks early, and seek alignment before executing major changes.
• Balance innovation with operational practicality and system limitations.
• Build strong cross-functional relationships to support sustainable process improvements.
• Other duties, as assigned.

Experience

• Minimum 10 years working experience in healthcare revenue cycle management with at least 5 years of managerial experience.
• Medicare guidelines and healthcare claims regulation knowledge
• Medicare Advantage claims adjudication is a plus.
• Experience with EMR software is a must.

Education

• Bachelor's Degree in a related field is preferred. In lieu of degree, 10 or more years of relevant experience.

Knowledge, Skills & Abilities

• Proficiency with computers and PC applications
• Intermediate to advanced knowledge of Microsoft Excel and Office products.
• Possess extensive knowledge of billing regulations for Medicare, commercial, HMO's and PPO's.
• Knowledge of patient privacy and maintains confidentiality of all sensitive information.

Work Hours, Travel Requirements

• Monday - Friday, 8:00 a.m. - 5:00 p.m., and as needed to complete projects.
• Travel to medical offices may be necessary for the purpose of providing benefit education.

Working Conditions & Physical Requirements

• This job operates in an office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets and fax machines.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. This is largely a sedentary role; however, some filing is required. This would require the ability to lift files, open filing cabinets and bend or stand on a stool as necessary. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.