About this role

Oversee and integrate billing operations for both Medical Benefit (J-Codes, HCPCS, CPT codes) and Pharmacy Benefit (NCPDP standards)
Design and execute "test billing" scenarios to identify new revenue streams
Apply deep knowledge of U.S. commercial payor policies to navigate complex Prior Authorization requirements
Collaborate with the Contracting team to ensure billing practices align with specific network rates
Audit existing RCM workflows to eliminate bottlenecks
Ensure all optimizations remain compliant with OIG, HIPAA, and CMS guidelines
Define and report on aggressive RCM metrics, including Days Sales Outstanding

Minimum 8–10 years of leadership in Specialty Pharmacy or Infusion RCM
Advanced expertise in Medical Benefit billing (CMS-1500/UB-04) and Pharmacy Benefit billing (NCPDP)
Comprehensive knowledge of national and regional commercial insurance reimbursement policies and "White Bagging/Brown Bagging" dynamics
Proficiency in data analytics tools (Excel, PowerBI, or Tableau)
Bachelor’s degree in finance or healthcare administration, or related field (Master’s or CPC/CPB certification preferred)

Performance Bonus (Quarterly/Annual)
Multi-factor scorecard designed to reward operational excellence and financial growth
Incentives for reducing Days Sales Outstanding below a specific target
Bonuses tied to keeping the initial denial rate below 5%

Director of Billing, Revenue Cycle Optimization

Key skills