Director of Revenue Cycle Management

Job Summary:

The Director of Revenue Cycle provides strategic leadership and operational oversight of William Newton Hospital’s (WNH) entire revenue cycle function, including patient access, billing, coding, claims, denials management, accounts receivable, and payer relations. This position is responsible for achieving revenue goals established through WNH’s organizational planning and goal-setting processes, as approved by the CFO. The Director develops and implements strategies to maximize third-party revenue, improve collections, reduce denials, and ensure compliance across all payer types, including Medicaid, Medicare, commercial insurance, and VA, etc. The Director reports to the Chief Financial Officer. This position builds and leads a sustainable team structure with sufficient cross-training and depth to ensure continuity of operations.

Standards of Behavior

William Newton Hospital’s Standards of Behavior allow a mechanism for holding each employee accountable and encourages us to "raise the bar". All employees are expected to familiarize themselves with the Standards and practice them daily.

• i - Integrity

We act with unwavering moral principle,

transparency, and sincerity in every

interaction.

• P - Patient-Centered

We meet patients where they are, ensuring

the are active participants in their care

journey. We prioritize the patient's physical

and emotional well-being over all else.

• A - Accountability

We own our actions. We set clear

expectations and hold all team members to

the same high standards.

• C - Compassion

We treat every patient, family member, and

colleague with kindness, empathy, and

dignity.

• E - Excellence

We approach every task, large or small, with

enthusiasm. We continually pursue mastery

and best practices in our field.

Job Duties & Responsibilities

Strategic Revenue Growth & Operations

• Develop and execute revenue cycle strategies aligned with organizational revenue goals approved by the CFO, working collaboratively with the executive leadership to achieve financial targets.
• Monitor payer mix trends, identify shifts impacting revenue, and implement corrective strategies to protect and grow high-value reimbursement streams, including ensuring patients are enrolled in available coverage programs.
• Develop revenue models, billing workflows, and staffing plans for new and expanding service lines prior to launch, ensuring billable services are operationally supported before patient volume scales.
• Oversee end-to-end revenue cycle performance across all billing platforms and service lines, ensuring timely claim submission, accurate coding, and maximum reimbursement.
• Recommend and propose revenue cycle investments, technology enhancements, and staffing adjustments to the CFO and CEO for approval, including budget justification aligned with projected revenue impact.

Denial Management & Accounts Receivable

• Provide strategic oversight of the denial management function, including review of trending data, root cause analysis, and systemic interventions to reduce denial rates and improve recovery.
• Establish and enforce AR aging thresholds, write-off policies, and escalation protocols; develop and maintain KPI policy frameworks defining targets if such policies do not yet exist.
• Monitor net collection rates, days in AR, clean claim rate, and other key performance indicators by payer and service line; present performance reports and variance analysis to the CFO and executive leadership.

Patient Access & Front-End Revenue Integrity

• Provide oversight and standards for patient access functions, including registration accuracy, insurance verification, eligibility confirmation, prior authorization, and point-of-service collections.
• Ensure consistent patient access standards across all service lines and locations, working collaboratively with clinical program leadership to align front-end processes with billing requirements.
• Oversee patient financial counseling and coverage enrollment assistance, collaborating cross-departmentally to ensure eligible patients are connected with available insurance programs, tribal sponsorship, or financial assistance.

Coding & Charge Capture

• Oversee coding operations to ensure accuracy, compliance, and timeliness across all service lines and coding systems (CPT, ICD-10-CM, CDT, HCPCS).
• Establish coding quality assurance processes, including periodic audits, provider education, and feedback loops to improve documentation and reduce coding-related denials.
• Monitor charge capture workflows and chart closure timelines; partner with clinical leadership and health information management to reduce DNFB and coding lag.

Payer Relations & Contract Management

• Serve as WNH’s subject matter authority on payer requirements, reimbursement methodologies, and contract terms; prepare analysis and recommendations for payer contract negotiations, with final authority resting with the CEO/CFO.
• Monitor fee schedule updates, regulatory changes, and payer policy shifts affecting reimbursement; communicate impacts to the revenue cycle team and executive leadership.
• Monitor provider enrollment status across all active payers in coordination with credentialing staff; enforce enrollment service level agreements and escalate delays impacting billing readiness.

Systems & Technology

• Oversee revenue cycle operations across all billing and practice management platforms used by the organization, ensuring workflow efficiency, data integrity, and system interoperability.
• Collaborate with IT, clinical leadership, and external partners on the evaluation, selection, design, implementation, and ongoing optimization of electronic health record (EHR) and billing systems.
• Document and escalate system issues affecting revenue cycle operations; represent WNH’s revenue cycle requirements in technology governance and partnership forums.
• Serve as a WNH representative on applicable WNH advisory committees related to health information systems and technology partnerships.

Staff Leadership & Development

• Recruit, develop, and retain a high-performing revenue cycle team; directly supervise specialized staff and ensure adequate staffing levels across all functions.
• Build team capacity through cross-training, process documentation, and succession planning to ensure the function operates sustainably.
• Foster a culture of continuous improvement, accountability, and professional development within the team.
• Conduct performance evaluations, provide coaching and mentorship, and address performance issues in accordance with WNH policies and procedures.

Compliance, Reporting & Cultural Sensitivity

• Ensure all revenue cycle operations comply with applicable federal, state, and tribal regulations, including HIPAA, CMS guidelines, IHS, and applicable confidentiality requirements for specialized programs.
• Partner with the Quality Director on compliance program activities related to billing, coding, and documentation; the Director does not hold primary compliance program authority.
• Prepare and present revenue cycle reports to the CFO, executive leadership as requested, including performance metrics, trend analysis, and strategic recommendations.
• Uphold and promote cultural sensitivity in all revenue cycle interactions, ensuring that financial processes respect the unique needs, values, and cultural practices of WNH.
• Other related duties as assigned.