Overview: The Medical Director of Revenue Cycle plays a critical role in overseeing and optimizing the financial operations within the healthcare organization. This individual is responsible for developing and implementing strategies to maximize revenue, minimize financial risk, and ensure compliance with regulatory requirements. The ideal candidate will possess a deep understanding of healthcare revenue cycle management, coupled with strong leadership and analytical skills.

Responsibilities:

1. Strategic Leadership:

   • Develop and implement strategic initiatives to optimize revenue cycle performance, enhance financial outcomes, and support organizational goals.
   • Collaborate with executive leadership to establish key performance indicators (KPIs) and benchmarks for revenue cycle metrics.
   • Provide guidance and direction to revenue cycle staff, fostering a culture of accountability, efficiency, and continuous improvement.

2. Revenue Cycle Management:

   • Oversee all aspects of the revenue cycle, including patient registration, coding, billing, collections, and accounts receivable management.
   • Ensure accurate and timely billing processes in compliance with regulatory guidelines, payer requirements, and contractual obligations.
   • Monitor revenue cycle workflows and identify opportunities for process improvement and automation to streamline operations and maximize revenue capture.

3. Financial Analysis and Reporting:

   • Analyze revenue cycle data and financial performance metrics to identify trends, variances, and areas for improvement.
   • Prepare regular reports and presentations for senior leadership, highlighting key performance indicators, revenue projections, and actionable insights.
   • Develop and implement strategies to address revenue leakage, denials, and other financial challenges impacting revenue cycle operations.

4. Compliance and Regulatory Compliance:

   • Ensure compliance with federal, state, and local regulations governing healthcare billing, coding, and reimbursement.
   • Stay abreast of changes in healthcare regulations and payer policies, and implement necessary updates to revenue cycle processes and procedures.
   • Collaborate with compliance officers and legal counsel to address compliance issues and mitigate financial risks.

5. Relationship Management:

   • Collaborate with internal stakeholders, including clinical departments, finance, IT, and compliance, to optimize revenue cycle processes and workflows.
   • Build and maintain effective relationships with external stakeholders, including third-party payers, government agencies, and regulatory bodies.
   • Serve as a subject matter expert on revenue cycle matters, providing education and guidance to internal and external stakeholders as needed.

Qualifications:

• Medical degree (MD or DO) with board certification in a relevant specialty (e.g., Internal Medicine, Family Medicine, etc.) preferred.
• Minimum of [X] years of experience in healthcare revenue cycle management, with demonstrated leadership experience in a managerial or director-level role.
• Strong understanding of healthcare billing, coding, reimbursement methodologies, and regulatory requirements (e.g., CMS guidelines, HIPAA, etc.).
• Proficiency in revenue cycle technologies, EMR/EHR systems, and healthcare billing software (e.g., Epic, Cerner, Meditech, etc.).
• Excellent analytical, problem-solving, and decision-making skills, with the ability to analyze complex financial data and develop actionable recommendations.
• Effective communication and interpersonal skills, with the ability to collaborate and build relationships across all levels of the organization.
• Proven track record of driving process improvement initiatives, achieving measurable results, and managing change in a dynamic healthcare environment.