United States onlyThe Sr. Director, Revenue Cycle Optimization is a key leader responsible for driving financial performance and operational efficiency across the Revenue Cycle Management (RCM) team. This role oversees offshore vendor partnerships, directs Robotic Process Automation (RPA) initiatives for RCM, and manages Revenue Optimization and Revenue Integrity functions. Key areas of focus include auditing payer performance, identifying underpayment trends, managing charge alerts, addressing downcoding opportunities, and providing strategic oversight of the chargemaster to ensure accurate revenue capture and compliance. This role is vital to enhancing revenue integrity, strengthening operational efficiency, and driving sustained financial growth through strategic leadership and data-driven decision-making.
Primary Job Duties:
- Lead and mentor high-performing teams across Revenue Optimization and Revenue Integrity functions.
- Develop and execute strategic plans that support growth, operational efficiency, and market expansion.
- Foster collaboration across departments to support enterprise-wide financial and operational goals.
- Lead the strategy, performance, and relationship management of offshore RCM vendors to align with organizational goals.
- Develop and manage performance metrics to ensure vendor accountability and operational success.
- Identify and implement process improvements through offshore partnerships to drive efficiency and cost savings.
- Drive automation strategies to optimize operational workflows and increase accuracy across the revenue cycle teams.
- Collaborate with IT and operational teams to implement scalable RPA solutions.
- Monitor, refine and prioritize automation processes to maximize performance and return on investment.
- Oversee the Revenue Optimization team responsible for chargemaster setup, accuracy and athenaOne billing rules to ensure compliance and optimal revenue capture.
- Develop and execute strategies to improve revenue capture and reduce financial leakage.
- Lead the Revenue Integrity teams responsible for payer performance audits, focusing on underpayments, denials, and reimbursement trends.
- Partner with compliance and operational teams to mitigate financial risks and capitalize on revenue opportunities.
- Other duties as assigned.
- Bachelor’s degree in Business, Finance, Healthcare Administration, or a related field preferred.
- 8+ years of experience in Revenue Cycle Management, Revenue Optimization, or related areas.
- Strong people management experience required
- Offshore resource management experience preferred
- Proven expertise in payer auditing, underpayment recovery, and chargemaster oversight.
- Strong analytical and problem-solving skills with a strategic mindset.
- Excellent leadership, communication, and cross-functional collaboration abilities.
- Advanced Microsoft Excel skills strongly preferred (ex: VLOOKUP, sort/filtering/formatting, pivot table, and formulas).
- Experience using Athena EHR required
- Cognizant TriZetto products preferred
- Experiene using Salesforce for case management
- Experience with RPA tools and process automation preferred.
- In-depth knowledge of payer reimbursement policies and revenue cycle compliance preferred.
The salary range for this role is $145,000.00 to $150,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 20% and restricted stock units. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location.
All your information will be kept confidential according to EEO guidelines.
Technical Requirements (for remote workers only, not applicable for onsite/in office work):
In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.
Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
