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Director of Revenue Cycle Management

🕒 23 days ago
Revenue Cycle ManagementClaims OperationsHealthcare ITAthena EMR

📜 Description

  • Serve as the primary owner of Athena claim edit rules and workflow configuration related to non-FFS billing.
  • Partner with Athena's support team to build custom rules that prevent inappropriate low-dollar claim edits.
  • Ensure claims reach payers as intended and reconcile discrepancies between submissions and payments.
  • Design and maintain reports on claim submission status, holds, and payment tracking.
  • Lead a 90-day assessment of Athena's fit for the billing model and recommend potential migrations.

🛠️ Requirements

  • 6+ years of revenue cycle management or claims operations experience in healthcare.
  • Practical experience configuring Athena (or a comparable EMR/RCM platform), including working with vendor support/professional services teams on custom edit rules and workflow changes.
  • Ability to read and interpret payer contract language and translate contractual terms into system requirements.
  • Strong analytical and reporting skills; comfortable building reconciliation reports and communicating findings to finance leadership.
  • Demonstrated ability to work cross-functionally with finance, operations, and external vendor teams, and to advocate persistently when a vendor's default assumptions don't fit the business model.
  • Prior experience evaluating or migrating between EMR/RCM platforms.
  • Familiarity with encounter data reporting standards and delegated/capitated payer relationships.
  • Certification such as CRCR (Certified Revenue Cycle Representative) or equivalent.
  • Experience managing or mentoring junior billing/claims staff.
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