VP of Revenue Cycle Management

Summary of Responsibilities

• Develop and execute the orthopedic revenue cycle strategy in alignment with organizational goals.
• Establish performance standards, workflows, and accountability measures for all orthopedic RCM functions.
• Identify opportunities to improve reimbursement, reduce leakage, and optimize financial performance.
• Partner with executive leadership to develop long-term revenue cycle initiatives and growth strategies.
• Provide regular reporting and analytics to executive leadership regarding revenue cycle performance and trends.

• Provide oversight and accountability for all aspects of orthopedic revenue cycle operations, including:
• Charge capture and charge reconciliation
• Coding and documentation review
• Surgical billing and reimbursement optimization
• Prior authorization management
• Claim submission and claim edits
• Payment posting and reconciliation
• Denial prevention and denial management
• Appeals and underpayment recovery
• Accounts receivable management
• Patient financial services and collections
• Contract reimbursement analysis
• Revenue integrity initiatives
• Compliance with payer regulations and billing requirements

• Oversee revenue cycle processes for orthopedic surgical procedures, ambulatory surgery centers, office-based procedures, imaging, DME, physical therapy, and ancillary services.
• Ensure accurate capture and billing of complex surgical cases.
• Monitor and improve reimbursement for operative services, implant-related procedures, injections, regenerative medicine services, diagnostics, and specialty programs.
• Partner with physicians and clinical teams to enhance documentation supporting reimbursement.

• Develop aggressive denial prevention and recovery strategies.
• Monitor denial trends by payer, provider, location, procedure, and service line.
• Establish action plans to reduce aging AR and improve collection rates.
• Lead payer dispute resolution and escalation efforts when necessary.
• Ensure timely appeal submission and follow-through.

• Build and structure a specialty orthopedic RCM department capable of supporting organizational growth.
• Recruit, hire, train, mentor, and retain high-performing team members.
• Develop leadership succession plans and career development pathways.
• Conduct ongoing coaching, performance management, and staff development.
• Foster a culture of accountability, continuous improvement, and operational excellence.

• Establish and monitor key performance indicators (KPIs) including:
  • Net Collection Rate
  • Days in Accounts Receivable
  • Clean Claim Rate
  • Denial Rate
  • First Pass Resolution Rate
  • Surgical Collection Yield
  • Cash Collections
  • Bad Debt Percentage
  • Patient Collection Metrics
  • Payer Performance Indicators
• Lead process improvement initiatives utilizing data-driven decision making.
• Implement automation and technology solutions to improve efficiency and scalability.

• Ensure compliance with all federal, state, payer, and contractual billing requirements.
• Maintain working knowledge of Medicare, Medicaid, Commercial Insurance, Workers' Compensation, and Personal Injury reimbursement methodologies.
• Collaborate with compliance teams on audits, investigations, and corrective action plans.
• Ensure proper implementation of coding and documentation guidelines.

• Bachelor's Degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field required.
• Master's Degree preferred.

• Minimum 10 years of progressive healthcare revenue cycle leadership experience.
• Minimum 5 years managing orthopedic or surgical revenue cycle operations.
• Demonstrated success leading multi-function RCM teams.
• Extensive experience with orthopedic surgical billing and reimbursement methodologies.
• Proven experience improving cash collections, reducing denials, and increasing operational efficiency.
• Experience managing physician practice revenue cycles, surgical services, ancillary services, and specialty billing operations.

• Deep understanding of orthopedic practice operations and reimbursement.
• Advanced knowledge of revenue cycle workflows and best practices.
• Strong understanding of CPT, ICD-10, HCPCS, modifier utilization, and payer policies.
• Expertise in denial management and AR optimization.
• Financial analysis and reporting proficiency.
• Strong leadership, coaching, and team-building capabilities.
• Exceptional communication and executive presentation skills.
• Ability to lead organizational change and process improvement initiatives.

• Increased cash collections and revenue realization
• Reduction in denied claims and denial write-offs
• Improved clean claim submission rates
• Improved AR aging performance
• Achievement of KPI targets established by executive leadership
• Successful development and retention of orthopedic RCM staff
• Increased reimbursement accuracy and compliance
• Implementation of scalable processes supporting organizational growth
• Strong physician and operational stakeholder satisfaction

• Strategic Thinking
• Financial Acumen
• Accountability
• Team Development
• Operational Excellence
• Change Management
• Data-Driven Decision Making
• Cross-Functional Collaboration
• Continuous Improvement
• Results Orientation

Bachelor's degree required; master's preferred. Requires 10+ years of healthcare revenue cycle leadership, 5+ years managing orthopedic or surgical RCM, and experience leading multidisciplinary teams.

Key Responsibilities

• leading RCM
• optimizing reimbursement
• managing denials

Job Details

• Category: Finance and Accounting
• Seniority: Senior Level
• Commitment: Full Time
• Workplace: Remote — Matawan, New Jersey, United States
• Salary: USD 150,000 – 180,000 / year
• Languages: English

Benefits

• Retirement plan

About Alliance Health Systems

A healthcare management company providing operational, administrative, and strategic support to healthcare organizations and providers. — Industry: Healthcare