Director, Revenue Cycle at Upward Health

RemoteFull-timeRemoteFinancePosted 9 days ago

About the Role

<h2>Company Overview</h2> Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team—from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff—is driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs because we know that health requires care for the whole person. <h2>Job Title & Role Description</h2> The Director, Revenue Cycle is the enterprise owner of end-to-end revenue cycle performance across Upward Health’s operations. This role is accountable for the accuracy, efficiency, and scalability of all revenue cycle functions—including charge capture, coding, billing, claims submission, denial management, and collections. This position operates as a hands-on leader, combining operational oversight with data-driven performance management in a complex, multi-system environment. The Director is responsible for optimizing workflows across Athenahealth and third-party platforms, while leveraging analytics, automation, and emerging AI tools to enhance outcomes and reduce administrative burden. The role partners closely with finance, operations, clinical, and IT leadership to ensure that revenue cycle processes are aligned with organizational goals and evolving payer requirements. The Director will also lead teams across billing, coding, and accounts receivable functions, establishing a culture of accountability, continuous improvement, and data-driven decision-making. <h3>Skills Required: </h3> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">7–10+ years of progressive experience in revenue cycle management</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Direct, hands-on experience with Athenahealth</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Advanced Excel skills, including data modeling and reporting automation</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Strong analytical mindset with high attention to detail</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Proven track record improving revenue cycle KPIs and operational efficiency</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Experience implementing process improvements and workflow automation</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Demonstrated ability to quickly learn and adapt to new systems</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Experience leading teams within a healthcare billing or revenue cycle environment</li> </ul> <h3>Preferred</h3> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Experience in value-based care or risk-based contracting environments</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Familiarity with EDI transactions (835/837) and clearinghouse operations</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Experience leveraging AI or automation tools in healthcare operations</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Bachelor’s degree in Healthcare Administration, Finance, or related field (Master’s preferred)</li> </ul> <h2>Key Responsibilities</h2> <h3>Revenue Cycle Operations</h3> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Oversee all aspects of the revenue cycle, including intake, eligibility verification, coding, charge entry, claims submission, AR follow-up, denial management, and payment posting</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Establish and monitor KPIs such as days in AR, denial rate, first-pass resolution rate, and net collection rate</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Identify root causes of revenue leakage and implement corrective actions</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Ensure timely, accurate claims submission and reimbursement across all payer types</li> </ul> <h3>Athenahealth Optimization</h3> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Serve as the internal subject matter expert for Athenahealth practice management and billing workflows</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Configure and optimize system rules, edits, and reporting to maximize efficiency and clean claim rates</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Partner with IT and operations on enhancements, automations, and integrations</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Troubleshoot system issues and drive continuous improvement in platform utilization</li> </ul> <h3>Data Analytics & Reporting</h3> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Leverage advanced Excel capabilities (pivot tables, XLOOKUP, Power Query) to analyze large datasets</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Build and maintain dashboards and reporting tools for leadership</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Translate complex data into clear insights and operational improvements</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Ensure data integrity across systems and reporting outputs</li> </ul> <h3>Process Improvement & Automation</h3> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Design, document, and standardize SOPs across the revenue cycle</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Identify and implement workflow improvements to reduce manual intervention</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Drive scalable process enhancements that support organizational growth</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Establish measurable performance metrics and accountability standards</li> </ul> <h3>AI & Workflow Innovation</h3> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Identify and implement AI-enabled tools to optimize revenue cycle processes (e.g., denial prediction, coding support, automation)</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Evaluate emerging technologies and vendors for efficiency and accuracy improvements</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Lead pilots and deployments of automation solutions that reduce administrative burden</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Develop a forward-looking roadmap for AI integration across revenue cycle functions</li> </ul> <h3>Compliance & Risk Management</h3> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Ensure compliance with payer requirements, CMS guidelines, and regulatory standards (including HIPAA)</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Monitor audit outcomes and implement corrective actions</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Maintain accurate documentation and coding integrity</li> </ul> <h3>Leadership & Team Development</h3> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Lead and develop teams across billing, coding, and AR functions</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Establish performance expectations and provide ongoing coaching</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Foster a culture of accountability, continuous improvement, and operational excellence</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Partner cross-functionally with clinical, operational, and finance leaders</li> </ul> <h2>Key Competencies</h2> <ul> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Detail-oriented and highly organized</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Data-driven decision-making</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Strong systems thinking and process design capabilities</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Technologically forward, with a focus on AI and automation</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Effective communicator with ability to translate data into action</li> <li style="font-family: arial, helvetica, sans-serif; font-size: 12pt;">Results-driven with strong accountability and execution focus</li> </ul>   Upward Health is proud to be an equal opportunity employer committed to attracting, retaining, and supporting a diverse and inclusive workforce. This job description outlines the general responsibilities of the role and is not intended to be an exhaustive list of all duties; additional responsibilities may be assigned as needed to support organizational, operational, or patient care needs.  <div class="content-conclusion"><a href="https://flimp.live/Upward-Health-Benefits-2025-26">Upward Health Benefits</a> <a id="menur3se" class="fui-Link ___1q1shib f2hkw1w f3rmtva f1ewtqcl fyind8e f1k6fduh f1w7gpdv fk6fouc fjoy568 figsok6 f1s184ao f1mk8lai fnbmjn9 f1o700av f13mvf36 f1cmlufx f9n3di6 f1ids18y f1tx3yz7 f1deo86v f1eh06m1 f1iescvh fhgqx19 f1olyrje f1p93eir f1nev41a f1h8hb77 f1lqvz6u f10aw75t fsle3fq f17ae5zn" href="https://upwardhealth.com/core-values/" target="_blank">Upward Health Core Values</a> <a href="https://www.youtube.com/channel/UCl7dDJIXybzdmVqnh-OI9Ug">Upward Health YouTube Channel</a>    </div>

About the Role

About the Role

Related Roles

About the Role

Related Roles