Job#:2231 - Revenue Cycle Management (RCM) Program Director
Job Description:
Key Responsibilities
Strategic Leadership: Drive end-to-end revenue cycle operations and strategy to optimize net collections, reduce denial rates, and improve A/R days across DSOHF facilities.
System & Workflow Governance: Lead Epic revenue cycle system optimization (Prelude, Cadence, Resolute HB/PB), automation, analytics, and reporting.
Compliance & Reimbursement: Manage complex Medicaid, Medicaid Managed Care, Medicare, and commercial billing; ensure strict adherence to CMS, HIPAA, and state regulations while maintaining audit readiness.
Stakeholder & Operations Alignment: Partner with senior leadership, state agencies, and payer organizations to align clinical operations, finance, and IT with overall financial goals.
Required Skills & Qualifications (5+ Years Each)
Full-Cycle RCM: Comprehensive experience across patient access, HIM/coding, billing, A/R, and denials.
Payer Expertise: In-depth knowledge of Medicaid, Medicaid Managed Care, Medicare, and commercial reimbursement models.
Enterprise Leadership: Proven track record managing enterprise revenue cycle teams and departmental managers.
KPI Management: Expertise in driving key metrics (A/R days, clean claim rate, denial rate, net collections).
Regulatory & Audit Control: Deep understanding of CMS, HIPAA, state policies, and internal compliance frameworks.
Epic Proficiency: Hands-on experience with Epic RCM modules (Prelude, Cadence, Resolute HB/PB) and workflow management.
Executive Communication: Demonstrated ability to report complex financial, operational, and regulatory insights to executive leadership.
Specialized Facility Domain Knowledge: Direct background managing RCM operations for behavioral health, psychiatric care, developmental disabilities, or state-operated facilities.
