Associate Director, Revenue Cycle Management Audit and Process Improvement

We are seeking an experienced and strategic Associate Director, Revenue Cycle Management Audit and Process Improvement to build and manage a comprehensive audit program for our revenue cycle processes and personnel. The ideal candidate will have a proven track record of leading revenue cycle audits, preferably within the labs/medical testing industry, and possess a deep understanding of the entire labs process from sample intake to billing.

Key Responsibilities

• Develop, implement, and manage a comprehensive audit program for revenue cycle, including process and personnel audits
• Direct audits and analysis, identify trends, present opportunity areas, and prioritize initiatives for performance improvement
• Identify areas of risk and recommend strategies to mitigate potential revenue loss
• Monitor key performance indicators and SLAs to ensure optimal process and personnel performance
• Collaborate with cross-functional teams, especially billing, to address audit findings and implement corrective actions
• Review and improve auditing templates with an effective scoring methodology to monitor RCM team performance
• Modify workflows, SOPs, and SLA tracking based on audit findings
• Oversee vendor operations teams to ensure accurate and timely processing for optimal reimbursement
• Lead weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities
• Develop performance goals and metrics aligned with the organization's strategy
• Supervise and mentor audit staff to enhance professional development

Qualifications

• Bachelor's degree in Accounting, Business, Healthcare related field, or equivalent experience
• 8-10 years of related experience in medical billing and/or insurance collections, including 5-7 years of experience with Prior Authorization requirements, AR & Denial management, payer utilization management policies, and appeals
• Certified in coding or similar coding management experience
• Proven experience leading revenue cycle audits and managing audit programs
• Lab & Diagnostic industry-based RCM experience
• Management experience required

Required Skills

• Ability to analyze information and create compelling stories at the executive level
• Understanding of the entire labs process and ability to create scalable processes
• Knowledge of denial reasons and resolution strategies
• Strong communication and collaboration skills
• Proficiency with medical billing systems, Microsoft Excel, medical terminology, and basic procedure coding
• Motivated to be creative and brainstorm innovative solutions
• Desire to work for a dynamic and growing molecular genetics laboratory

If you are passionate about driving performance improvement in revenue cycle management and thrive in a fast-paced, innovative environment, …