Director Clinical Revenue Cycle Jobs in Riverside, CA

Description

JOB SUMMARY

The Director of Revenue   Cycle is responsible for overseeing all aspects of the revenue cycle process   within the organization, including patient access, billing, collections,   coding, reimbursement, and compliance. This position ensures that revenue   cycle operations align with federal and state regulations, payer   requirements, and organizational financial goals. The Director will lead   teams across patient financial services, health information management, and   billing functions to optimize efficiency, reduce denials, and maximize   revenue capture.

DISTINGUISHING   CHARACTERISTICS

This role requires a   highly strategic leader with expertise in healthcare finance, regulatory   compliance, payer relations, and revenue cycle technology. The Director must   balance operational leadership with regulatory knowledge (e.g., CMS, HIPAA,   Medi-Cal, Medicare, and commercial payers), while maintaining strong   communication with clinical and administrative departments.

ESSENTIAL JOB   DUTIES & RESPONSIBILITIES:

The following are exemplary essential job duties and   responsibilities and are not intended to represent an all-inclusive listing   of related essential functions of the position.

Leadership   & Strategy

Develop and implement revenue cycle strategies to ensure timely   and accurate billing, collections, and reimbursement.

Lead, mentor, and evaluate teams in patient access, billing,   coding, and collections.

Collaborate with clinical and administrative leaders to improve   workflows affecting reimbursement.

Financial Performance

Monitor key performance indicators (KPIs) such as days in   accounts receivable (AR), denial rates, collection efficiency, and cash flow.

Develop revenue cycle dashboards and reports for executive   leadership.

Identify areas for process improvement and implement corrective   actions.

Compliance & Risk Management

Ensure adherence to state and federal regulations (California   Department of Health Care Services, Medi-Cal, Medicare, HIPAA).

Maintain compliance with payer contracts, coding regulations,   and billing requirements.

Lead internal audits and respond to payer audits or inquiries.

Revenue Integrity & Technology

Oversee charge capture, coding accuracy, and documentation   improvement initiatives.

Implement and optimize revenue cycle technologies, including EHR   and billing systems.

Partner with IT and compliance departments to strengthen revenue   integrity.

Stakeholder Engagement

Serve as primary liaison between the organization and   third-party payers.

Develop and maintain effective communication with patients   regarding financial responsibilities.

Educate clinical and administrative staff on revenue cycle best   practices.

OTHER WORK AS   REQUIRED/REQUESTED

May be assigned special project or other assignments   and work tasks that are generally within the scope and level of the position,   and relative to the need for flexible Company operations.

MINIMUM &   PREFERRED QUALIFICATIONS:

Education/Training

Minimum: Bachelor's degree in Healthcare Administration,   Finance, Business

Preferred: Master's degree preferred

Experience

Minimum: 7-10 years of progressive experience in   healthcare revenue cycle management, with at least 3 years in a senior   leadership role. Strong knowledge of Medi-Cal, Medicare, commercial   insurance, and California-specific payer regulations. Expertise in medical   billing, coding, compliance, and reimbursement methodologies. Experience with   EHR and revenue cycle management systems (e.g., Epic, Cerner, Allscripts).

Any combination of educational and   work experience that would be equivalent to the stated minimum requirements   would qualify for consideration of this position.

Skills, Knowledge & Abilities

Advanced knowledge of revenue cycle processes, payer regulations, and   healthcare reimbursement.

Strong financial and analytical skills, with ability to interpret   complex data.

Excellent leadership, communication, and conflict resolution skills.

Ability to work collaboratively with physicians, administrators, and   external stakeholders.

Strong problem-solving skills with an emphasis on process improvement

Requirements

Education/Training

Minimum: Bachelor's degree in Healthcare Administration,   Finance, Business

Preferred: Master's degree preferred

Experience

Minimum: 7-10 years of progressive experience in   healthcare revenue cycle management, with at least 3 years in a senior   leadership role. Strong knowledge of Medi-Cal, Medicare, commercial   insurance, and California-specific payer regulations. Expertise in medical   billing, coding, compliance, and reimbursement methodologies. Experience with   EHR and revenue cycle management systems (e.g., Epic, Cerner, Allscripts).