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Qualifications:
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- Bachelor’s degree in Health Administration, Business, Finance, or related field required.
- Master’s degree (MHA, MBA, or MPH) preferred.
- Minimum of 7–10 years progressive experience in hospital revenue cycle management, with at least 3–5 years in a leadership role.
- Demonstrated success managing large, multi-disciplinary teams in an acute care setting.
- Strong knowledge of California healthcare regulations, Medi-Cal, Medicare, commercial payer billing, and managed care contracting.
- Exceptional leadership, communication, and interpersonal skills.
- Strong analytical and problem-solving capabilities.
- Expertise in revenue cycle systems.
- Ability to manage complex projects and drive cross-functional initiatives.
Preferred
- Certified Revenue Cycle Executive (CRCE) – through HFMA
- Certified Professional Coder (CPC) – through AAPC
- CHFP, FHFMA or other finance/RCM-related certifications
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Duties &
Responsibilities:
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Job Summary
The Director of Revenue Cycle Management (RCM) provides strategic leadership and oversight for all revenue cycle operations at Oroville Hospital. This position is responsible for optimizing the end-to-end revenue cycle process — including patient access, billing, coding, charge capture, collections, and compliance — to ensure timely, accurate, and compliant reimbursement for services. The Director ensures adherence to California-specific regulations, federal healthcare laws, and payer requirements.
Duties
Leadership & Strategy
- Lead and develop high-performing teams across all RCM functional areas including Patient Access, Health Information Management (HIM), Billing, Collections, and Denials Management.
- Develop and execute revenue cycle strategies that align with hospital goals, financial performance targets, and cash collection performance.
- Collaborate with the Executive Team, department directors, and clinical teams to ensure patient-centered revenue cycle practices, effective and efficient AR management, and end-to-end operational excellence.
Operational Oversight
- Monitor the integrity of end-to-end revenue cycle functions including patient registration, insurance verification, pre-authorization, coding, claims processing and follow up, denials management, and credit balance management.
- Monitor and manage in metric-driven environment using KPIs such as AR days, cash collections, denial rates, and bad debt; implement performance improvement plans as needed.
- Ensure accurate charge capture, billing, and reimbursement in accordance with Medicare, Medi-Cal, and commercial payer regulations.
Regulatory Compliance
- Ensure compliance with all federal, state, and local laws including HIPAA, EMTALA, CMS billing rules, and California Department of Health Care Services (DHCS) policies.
- Stay current on changes to reimbursement methodologies and payer contract terms.
- Work closely with Compliance and Legal departments to identify and mitigate risk.
Technology & Process Improvement
- Partner with IT to evaluate and optimize RCM systems (e.g., EHR, billing software, clearinghouse).
- Drive automation and process improvements to reduce denials, improve clean claim rates, and enhance patient financial experience.
Financial Management
- Develop and manage department budgets and forecasts.
- Analyze financial reports and implement corrective actions to improve revenue capture and reduce revenue leakage.
- Oversee vendor relationships related to revenue cycle (e.g., third-party collections, outsourced coding or billing services).
- Coordinate with Finance and Accounting on effective revenue recognition practices during month-end close and year-end audits.
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