Job Description

Director of Business Office / Revenue Cycle

Position Summary

The Director of Revenue Cycle (also functioning as Director of the Business Office) is responsible for the overall leadership, strategy, and operational performance of all revenue cycle functions in a 40-bed rural Prospective Payment System (PPS) hospital and affiliated Rural Health Clinics. This hands-on leadership role oversees patient access, health information management (HIM/coding), patient financial services, billing, collections, denials management, and cash acceleration in a rural healthcare environment with limited resources and a high mix of Medicaid, charity care, and self-pay patients.

Essential Responsibilities

• Provides strategic direction and daily oversight of the entire hospital and clinic revenue cycle (front-end, mid-cycle, and back-end processes).
• Achieves and maintains best-practice key performance indicators including: Net days in A/R < 45, Clean claim rate > 96%, Denial rate < 6%, Point-of-service cash collections > 10% of net patient revenue, Aged A/R > 90 days < 18%
• Manages a combined staff of 8–14 employees (patient access, patient accounting, coding, and billing).
• Ensures accurate and timely charge capture, coding (ICD-10, CPT, HCPCS), and billing for inpatient (MS-DRG), outpatient (APC), emergency, and RHC services.
• Oversees patient registration, insurance verification, pre-authorization, financial counseling, charity care screening, and Medicaid eligibility assistance.
• Leads denial management and appeals process; identifies root causes and implements corrective action plans.
• Coordinates closely with the hospital’s third-party eligibility vendor and financial assistance programs.
• Maintains compliance with all federal, state, and payer regulations (Medicare Wage Index, 340B if applicable, HIPAA, etc.).
• Prepares and presents monthly revenue cycle dashboards and financial reports to the CFO, CEO, and Board of Directors.
• Develops and manages the department budget; identifies cost-saving opportunities.
• Serves as the primary liaison with outsourced billing/coding vendors (if applicable) and the hospital’s collection agency.
• Actively participates in performance improvement initiatives and patient satisfaction efforts.
• Stays current on rural-relevant reimbursement changes (RHC All-Inclusive Rate methodology, Texas Medicaid supplemental programs, etc.).

Required Qualifications

• Bachelor’s degree in Business Administration, Healthcare Administration, Finance, Accounting, or related field (Master’s preferred).
• Minimum 5–7 years of progressive revenue cycle leadership experience, with at least 3 years in a rural or PPS hospital setting.
• Strong working knowledge of Medicare Prospective Payment System principles, 340B (if eligible), RHC reimbursement, and rural-specific payment methodologies.
• Demonstrated success improving A/R days, cash collections, and denial rates in a resource-constrained environment.
• Proficiency with hospital information systems (CPSI/Evident, MEDITECH, Epic Community Connect, Cerner CommunityWorks, etc.), billing/edit software, and encoder/grouper tools.
• Certified Revenue Cycle Representative (CRCR), Certified Healthcare Financial Professional (CHFP), or similar credential strongly preferred.

Preferred Skills & Attributes

• Hands-on, roll-up-your-sleeves leadership style; comfortable working in a small, close-knit team.
• Exceptional analytical, problem-solving, and communication skills.
• Ability to build relationships with clinical staff, physicians, and the community.
• High degree of integrity and commitment to compliance

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