Director of Revenue Cycle & Billing

Ophthalmic Consultants of Boston is current seeking a dynamic Director for our Revenue and Billing group.

We are seeking a strategic and hands-on Director of Revenue Cycle and Billing to oversee and optimize the entire revenue cycle across multiple departments, including Front Desk Operations, Central Scheduling/Call Center, Credentialing, Billing, and Medical Claims Management. This leadership role requires a dynamic professional with deep expertise in healthcare operations, claims submission, payer relations, and staff development.
The successful candidate will lead high-volume operations, ensure compliance with industry standards, drive revenue growth, and foster a culture of excellence and accountability.Key Responsibilities:

• Lead and oversee the day-to-day operations of the Revenue Cycle, including Front Desk, Central Scheduling/Call Center, Credentialing, Billing, and Prior Authorization functions.
• Manage high volumes of inbound and outbound calls, ensuring quality assurance and call center performance metrics are met.
• Direct the submission of medical claims, denial management, and Accounts Receivable follow-up processes with a strong focus on accuracy and timely reimbursements.  This includes efforts to improve self-pay collections.
• Oversee prior authorizations and insurance appeal processes, coordinating closely with payers to ensure approval and minimize delays.
• Ensure accurate use of ICD-10, CPT, and HCPCS coding in collaboration with billing and clinical staff.
• Hire, train, and supervise revenue cycle billing and front-end teams, promoting continuous development and strong interdepartmental collaboration.  Lead regular training sessions and meetings with managers and staff. 
• Establish operational benchmarks, KPIs, and performance dashboards to measure efficiency and revenue impact.
• Work collaboratively with Finance, Compliance, and Clinical Operations to ensure alignment of financial goals and patient satisfaction.
• Lead initiatives in budgeting, cost reduction, and revenue optimization, using data analytics and financial modeling.
• Develop and present detailed revenue reports, forecasts, and presentations to executive leadership, offering insight into trends, opportunities, and performance.
• Ensure adherence to all regulatory requirements, including HIPAA, CMS, and payer-specific guidelines.
• Support the physicians with billing and reimbursement questions and help develop practice policies related to the revenue cycle.
• Serve as the key expert in the billing system (Epic Resolute) for staff, physicians, clinical, and administrative team members.

Qualifications:

• Bachelor’s degree in healthcare administration, Business, Finance, or a related field required
• 7–10 years of progressive experience in revenue cycle management, including at least 3 years in a director or senior management role.
• Proven experience managing high-volume patient access and billing operations, including scheduling, call centers, and prior authorizations.
• Advanced understanding of medical billing procedures, insurance processes, appeals, and payer communications.
• Strong knowledge of ICD-10, CPT, and medical coding principles.
• Skilled in staff hiring, training, and leadership with the ability to build and maintain high-performing teams.
• Demonstrated success in revenue analytics, budget oversight, and implementation of cost-saving measures.
• Proficiency with EHR and PM systems (e.g., Epic, Athenahealth, eClinicalWorks, NextGen).
• Excellent communication and presentation skills with the ability to influence across departments and leadership levels.