job overview

Insurance Operations job in Rochester, New York

Director, Revenue Cycle Management


As one of Upstate New York’s fastest growing urgent care providers, we’re looking for professionals that demonstrate a continual commitment to provide the highest quality, patient-centered care in a warm and friendly setting.  As reflection or our continued growth we have an opportunity to join our team as a Director of Revenue Cycle Management in East Syracuse, NY.

The Director, Revenue Cycle Management will lead revenue management and drive strategies for maximizing payment and is responsible for the continuous improvement and streamlining of all systems and processes. Determines appropriate and effective performance metrics and staff requirements for the RCM function to run with efficiency, accuracy and outstanding customer service; manages to metrics.  Assists and participates in the network objective of aggressive revenue growth including marketing efforts.  Actively researches and remains apprised of industry/ regulatory trends and best practices in order to ensure Company leadership in revenue cycle management.  Develops written procedures for the centralization and standardization of the revenue cycle; continually monitors changes in workflow as needed to improve productivity.  Develops relationships with governmental bodies, managed care organizations and other business partners.


Manages the collections cycle and write-off process ensuring write-off in a timely manner after thoroughly exhausting all efforts.  Plays an active role in the selection, recommendation, maximization and implementation of software.  Monitors compliance with all third party payer regulations, exception handling, appeals and denials.  Maintains confidentiality in compliance with HIPAA regulations.


Monitors the effectiveness of all revenue cycle activities to insure revenue is maximized within regulatory guidelines and assure continuing compliance.  Provides a high level of strategic and operational support to ensure seamless execution of claims and collections operations.  Develops, implements and monitors policies and protocols related to provider verifications and ensures compliance with organizational standards.  This role requires current, in-depth knowledge of governmental and commercial insurance rules and regulations.


Specific Responsibilities:

  • Manage and/or assist in key department or cross-functional projects.
  • Developing a strong sustainable team by attracting, developing, rewarding, and retaining talent.
  • Motivates diverse teams by exemplifying the company vision, mission, values, and culture.
  • Directs the development of training critical to the team’s success.
  • Forecasts department staffing needs and manages staffing levels, with a strong focus on developing and retaining strong talent. Develops and manages the department financial budget.
  • Works across the organization (field teams and practice support teams) to develop best-in-class practices that support best-in-class results.
  • Collaborate with Aspen Dental Management’s shared services functions that directly or indirectly support the revenue cycle function for Five Star.
  • Develops the service practices required to meet the high expectations of the organization.
  • Manage the EMR system and vendor, ensuring functionality and efficiencies are optimized. Effectively solve system issues internally or with third party vendor and extract data and perform analysis as needed. 
  • Ability to make recommendations for solutions that meet organizational goals.
  • Supports the maintenance and inputs of the monthly Accounts Receivable bad debt allowance and contractual allowance, and provides insights and commentary on specific collection issues.
  • Assist in month end close and reporting responsibilities, systems close and maintenance, report reconciliation and review.
  • Leads through continuous improvement to ensure optimal processes and controls are in place and aligned with Company growth.
  • Develop and lead effective cross-functional provider credentialing and enrollment processes.
  • Prepares information reports and analysis of system data utilizing ERM software and other tools for monthly management reporting. Present monthly RCM reporting to management.
  • Analyzes Profit and Loss statements and Accounts Receivable Agings, recommends changes in course of action.
  • Creates and manages department key performance indicators / metrics to monitor the effectiveness of collection efforts and timeliness of insurance billings.
  • Leads weekly Billing/ Payer meetings with status updates on projects, payor issues and general reporting on receivables.
  • Monitors industry and regulatory trends, develop and communicate plans to manage the impact of future health care reform.
  • Participate in third party payer negotiations, review contracts with payers, oversee resolution of contract payment issues, and assisting in collection efforts.
  • Vendor management, from sourcing, recommendations, negotiations, implementation, and auditing of contracted pricing arrangements.
  • Assist in external financial statement audits, insurance audits/inquiries, and internal compliance requests.
  • Travel of 30% - 50% expected, especially in the first year, in order to lead employees and establish process in a remote location
  • Manage and grow a remote team

Minimum Education and Experience

Education and Background:

  • Bachelor's degree required. Finance and/or advanced degree preferred.
  • 7+ years’ experience with in-depth working knowledge of medical billing and the insurance industries including reimbursement, EDI and electronic remittance processing.
  • Experience in a growing healthcare environment.
  • Strong working knowledge of the end-to-end revenue cycle from: charge master; health information; patient registration; coding; insurance verification; billing and claims processing; accounts receivable management; adjustments; remittance processing; and collections.
  • Strong working knowledge of EMR and other systems and technology that drives efficiency, productivity, and cost effectiveness.
  • Proven career progression with increasing levels of project experience and responsibility.
  • Proficient in Microsoft Office, including Excel, Word, and PowerPoint.
  • Knowledge of basic accounting principles.

Characteristics and Abilities:

  • Excellent oral and written communications, interpersonal and organizational skills.
  • Ability to read and analyze contracts.
  • Financial analysis of Revenue Cycle protocols.
  • Multiple project leadership, business partnering and cross department/matrix collaboration.
  • Self-management abilities and sound business judgment.
  • High level of experience and expertise with related software.
  • Flexibility to support and to adapt to change.

The Director or Revenue Cycle Management role offers an excellent compensation package in an environment that offers growth and career development.  For immediate consideration, apply today!  



All qualified applicants will be afforded equal employment opportunities without discrimination because of race, creed, color, national origin, sex, age, disability or marital status.

Available Locations

WellNow - Rochester, New York 14621 United States