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Description

Company: Southeast Primary Care Partners / Southeast Medical Group

Department: Revenue Cycle Management

Reports To: Chief Financial Officer 

FLSA Classification: Exempt

Location: Hybrid or Remote, with travel as required

Position Summary

The Senior Director of Revenue Cycle Management provides strategic and operational leadership for the full patient revenue cycle across Southeast Primary Care Partners and its affiliated medical practices. This position is responsible for improving revenue realization, accelerating cash flow, reducing revenue leakage, and establishing a consistent, scalable revenue cycle model across a growing, multi-state primary care organization. The Senior Director oversees key revenue cycle functions, including patient registration, eligibility, authorization, charge capture, coding, claims submission, reimbursement, payment posting, denial management, accounts receivable, patient collections, and revenue cycle analytics. This leader will partner closely with Finance, Operations, Clinical Leadership, Compliance, Information Technology, Provider Enrollment, and external vendors to improve financial performance while supporting a positive patient and provider experience. The successful candidate will be a hands-on, data-driven leader who can develop strategy, lead teams, improve processes, manage vendors, and resolve complex operational barriers affecting reimbursement and cash flow.

Requirements

Essential Duties and Responsibilities

Strategic and Operational Leadership

• Develop and execute a comprehensive revenue cycle strategy aligned with the organization's financial, operational, clinical, and growth objectives.
• Provide leadership and accountability across all revenue cycle functions.
• Establish standardized processes, policies, controls, and performance expectations across practices and markets.
• Serve as the organization's primary subject matter expert for billing, coding, reimbursement, collections, denial management, and revenue integrity.
• Advise executive leadership regarding revenue cycle performance, risks, staffing, technology, vendors, and improvement opportunities.
• Build, coach, and retain a high-performing revenue cycle leadership team.

Revenue Cycle Management

• Oversee the complete patient revenue cycle, including:
• Registration and demographic accuracy
• Insurance eligibility and authorization
• Charge capture and reconciliation
• Coding and documentation support
• Claims preparation and submission
• Payment posting and reconciliation
• Denial prevention and resolution
• Accounts receivable follow-up
• Patient billing and collections
• Credit balances, refunds, and payment plans
• Ensure charges are captured, coded, submitted, and collected accurately and timely.
• Identify root causes of revenue leakage and implement sustainable corrective actions.
• Improve front-end processes that affect reimbursement, including registration, eligibility, authorizations, referrals, and patient financial communication.
• Reduce claim edits, rejections, denials, underpayments, avoidable write-offs, and billing delays.
• Maintain clear escalation processes for payer, provider, patient, and operational issues.

Financial Performance and Analytics

• Establish and maintain revenue cycle dashboards and reporting.
• Monitor and improve key performance indicators, including:
• Net and gross collection rates
• Days in accounts receivable
• Accounts receivable aging
• Clean-claim and first-pass acceptance rates
• Initial and final denial rates
• Charge-entry and claim-submission lag
• Unbilled and held claims
• Underpayments and contractual variance
• Bad debt and preventable write-offs
• Patient collections
• Cost to collect
• Staff productivity and quality
• Develop performance targets and service-level expectations for internal teams and external vendors.
• Identify performance variation by payer, provider, practice, market, and employee.
• Develop corrective action plans and quantify the financial impact of improvement initiatives.
• Present clear, actionable revenue cycle reporting to executive, operational, and clinical leaders.

Denial Management and Payer Performance

• Develop an enterprise-wide denial prevention and management program.
• Establish standardized denial categories, root-cause analysis, ownership, and escalation procedures.
• Partner with Operations, Clinical Leadership, Coding, and Information Technology to address recurring denial drivers.
• Monitor payer payment accuracy, processing delays, policy changes, and contractual compliance.
• Identify and pursue underpayments, inappropriate reductions, and reimbursement variances.
• Support payer escalations, meetings, and reimbursement improvement initiatives.

Coding, Documentation, and Compliance

• Maintain oversight of professional coding, documentation quality, billing accuracy, and revenue integrity.
• Ensure coding and billing practices comply with applicable regulations, payer requirements, organizational policies, and recognized coding standards.
• Partner with clinical and compliance leaders to improve provider documentation and coding accuracy.
• Establish coding quality reviews, audits, education, and corrective action processes.
• Monitor coding-related denials, modifier use, downcoding, documentation gaps, and charge-capture issues.
• Support internal and external audits, payer reviews, and compliance investigations.
• Ensure overpayments, credit balances, refunds, and billing errors are researched and resolved appropriately.
• Promote ethical billing practices, transparency, and strong internal controls.

People Leadership and Development

• Recruit, lead, coach, and develop revenue cycle leaders and staff.
• Establish clear roles, productivity expectations, quality standards, and accountability measures.
• Develop staffing models based on claim volume, accounts receivable inventory, productivity, quality, and organizational growth.
• Implement structured onboarding, training, cross-training, and professional development programs.
• Create succession plans for critical revenue cycle positions.
• Foster a culture of service, collaboration, accuracy, accountability, and continuous improvement.

Collaboration and Stakeholder Partnership

• Partner with practice and market leaders to improve front-end processes and resolve local revenue cycle issues.
• Collaborate with physicians and clinical leaders to improve documentation, coding, and charge capture.
• Work closely with Finance on cash reconciliation, month-end close, forecasting, financial reporting, and accounts receivable valuation.
• Partner with Information Technology to optimize electronic health records, practice management systems, clearinghouses, interfaces, work queues, automation, and reporting.
• Communicate revenue cycle trends, risks, and priorities in a clear and actionable manner.
• Establish cross-functional governance for major revenue cycle initiatives.

Technology, Vendors, and Process Improvement

• Evaluate and optimize revenue cycle technology, automation, analytics, and workflow tools.
• Identify opportunities to reduce manual work, rework, duplicate processes, and inconsistent workflows.
• Oversee billing companies, clearinghouses, collection agencies, coding vendors, consultants, and technology providers.
• Establish clear service levels, performance standards, escalation procedures, and financial accountability for vendors.
• Evaluate the appropriate balance of internal, outsourced, and co-sourced revenue cycle functions.
• Lead vendor selection, contract evaluation, implementation, performance management, and renewal activities.
• Recommend changes when vendor performance, service, cost, or compliance does not meet expectations.

Growth and Integration

• Support revenue cycle due diligence for acquisitions, affiliations, new practices, providers, and services.
• Evaluate accounts receivable quality, payer mix, staffing, coding, systems, workflows, and compliance risks.
• Develop and execute revenue cycle integration plans for newly acquired or affiliated practices.
• Establish transition milestones, responsibilities, timelines, and performance expectations.
• Ensure new providers, locations, and services are prepared for timely and accurate billing.
• Standardize newly integrated practices while addressing legitimate payer, market, and system differences.

Minimum Qualifications

• Bachelor's degree in healthcare administration, business administration, finance, accounting, health information management, or a related field.
• Minimum of 10 years of progressively responsible healthcare revenue cycle experience.
• Minimum of five years of significant leadership experience overseeing managers, supervisors, or large revenue cycle teams.
• Demonstrated experience managing physician-practice or ambulatory revenue cycle operations.
• Extensive knowledge of professional billing, coding, reimbursement, denial management, collections, payer requirements, and accounts receivable.
• Proven success improving revenue cycle performance and delivering measurable financial results.
• Strong understanding of Medicare, Medicaid, commercial insurance, managed care, and patient-responsibility processes.
• Working knowledge of healthcare billing regulations, compliance requirements, and internal controls.
• Experience managing third-party vendors and outsourced services.
• Strong analytical, financial, communication, presentation, and problem-solving skills.
• Ability to lead effectively in a growing, multi-location, and matrixed organization.
• Proficiency with electronic health records, practice management systems, clearinghouses, analytics, and Microsoft Office applications.
• Ability to travel as required.

Preferred Qualifications

• Master's degree in healthcare administration, business administration, finance, or a related field.
• Experience supporting a large, multi-state, multi-location physician organization.
• Experience in primary care, value-based care, or population health.
• Experience with multiple electronic health record or practice management systems.
• Experience integrating acquired practices or supporting mergers and acquisitions.
• Experience managing centralized, outsourced, hybrid, or co-sourced revenue cycle models.
• Relevant professional certification, such as CRCR, CHFP, CPC, CPMA, or CMRS.

Physical and Mental Requirements

The requirements below are representative of those necessary to perform the essential functions of the position. Reasonable accommodations may be made for qualified individuals with disabilities.

• Ability to sit or stand for extended periods.
• Ability to operate computers and standard office equipment.
• Ability to communicate and comprehend instructions verbally and in writing.
• Ability to analyze detailed financial, operational, regulatory, and technical information.
• Ability to use logical reasoning for routine and complex problem-solving.
• Ability to manage multiple priorities in a fast-paced environment.
• Ability to lift, push, or pull objects weighing up to 50 pounds when required.
• Ability to travel to multiple locations based on business needs.

Equal Employment Opportunity

Southeast Primary Care Partners is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, national origin, age, disability, protected veteran status, genetic information, or any other characteristic protected by applicable law.