Sr Dir Revenue Cycle

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Public Partnerships LLC supports individuals with disabilities or chronic illnesses and aging adults, to remain in their homes and communities and “self” direct their own long-term home care. Our role as the nation’s largest and most experienced Financial Management Service provider is to assist those eligible Medicaid recipients to choose and pay for their own support workers and services within their state-approved personalized budget. We are appointed by states and managed healthcare organizations to better serve more of their residents and members requiring long-term care and ensure the efficient use of taxpayer funded services.

Our culture attracts and rewards people who are results-oriented and strive to exceed customer expectations. We desire motivated candidates who are excited to join our fast-paced, entrepreneurial environment, and who want to make a difference in helping transform the lives of the consumers we serve. (learn more at www.pplfirst.com).

Job Summary:

The Senior Director, Revenue Cycle provides strategic and operational leadership for a centralized enrollment, authorization, eligibility, billing, and reimbursement function. A proven change agent, this leader drives organizational transformation, challenges the status quo, and builds scalable solutions across the revenue cycle — including end-to-end clearinghouse management and EDI transaction optimization. This role ensures optimal net revenue performance, efficient operations, and compliance with regulatory requirements while supporting the organization's mission, vision, and values. The position partners with senior leadership to define performance standards, translate business strategies into execution, and lead high-performing teams to deliver strong financial and operational outcomes in a complex, fast-paced healthcare environment.

Duties and Responsibilities:

Strategic Leadership & Business Alignment

• Provides revenue cycle management leadership for centralized enrollment, authorization, eligibility, and reimbursement operations.

• Develops and translates business strategies into standard technology platform product offerings and roadmaps aligned with strategic financial goals.

• Responsible for the overall strategy and delivery of revenue cycle solutions.

• Assesses and responds to current and future internal and external healthcare trends to guide revenue cycle direction.

• Partners with senior leaders to establish operational performance standards and ensure expectations are consistently met or exceeded.

Financial Performance & Revenue Optimization

• Ensures optimal net revenue and minimum invested capital through:

• Integrity of authorizations and eligibility

• Strong billing policies

• Effective accounts receivable procedures

• Denials management and prevention

• Payer contract management

• Collaborates on contract terms to mitigate risk and maximize financial objectives.

• Drives efficient revenue cycle operations to generate optimal cash flow supporting organizational initiatives.

Operational Excellence & Execution

• Directs, manages, and implements revenue cycle programs and strategies across onboarding and implementation.

• Ensures efficient end-to-end operations across enrollment, eligibility, billing, and reimbursement processes.

• Establishes metrics, KPIs, dashboards, and reporting to monitor:

• Staff productivity

• Authorization and eligibility accuracy

• Enrollment files

• Billing activity

• Accounts receivable performance

• Manages and optimizes clearinghouse relationships (e.g., Waystar, Change Healthcare) to ensure accurate and timely claim submission, remittance processing, and EDI transaction integrity (837/835/271/270).

• Monitors clearinghouse edit and rejection rates and leads corrective action to minimize claim rework, submission delays, and remittance reconciliation errors.

• Serves as subject matter expert (SME) for RFP content to ensure accuracy and technical rigor in authorizations, eligibility, and reimbursement.

People Leadership & Talent Development

• Hires, develops, mentors, and leads a high-performing billing and reimbursement team.

• Builds organizational capability to support growth and long-term success.

• Holds staff accountable for achieving performance targets and business plans.

• Creates a collaborative, high-performance work environment focused on service excellence.

• May supervise up to 40 employees.

Collaboration & Stakeholder Engagement

• Works effectively with all levels of management to influence outcomes and lead change.

• Collaborates cross-functionally to align operational execution with business strategy.

• Partners internally and externally to ensure the best interest of the organization in contract and operational decisions

• Acts as a change agent, championing organizational transformation initiatives that streamline revenue cycle operations, eliminate inefficiencies, and build a culture of continuous improvement and accountability.

Compliance & Risk Management

• Ensures full compliance with all Federal and State regulations related to billing procedures.

• Maintains integrity and accuracy of authorization, eligibility, and reimbursement processes.

• Identifies and mitigates business risks through operational and contractual controls.

Analytics, Reporting & Continuous Improvement

• Applies advanced analytical and problem-solving skills to drive process improvements.

• Leverages data insights to influence decision-making and improve operational effectiveness.

• Establishes performance tracking systems and continuous improvement initiatives.

Required Skills:

• Ability to work effectively with all levels of management.

• Advanced analytical and problem-solving skills.

• Ability to influence change and lead teams through process improvement.

• Strong knowledge of billing policies, accounts receivable procedures, denials management and prevention as well as payer contract management.

• Ability to work independently and as part of a team in a fast-paced environment with multiple deadlines

• Excellent written and oral communication and presentation skills.

• Ability to successfully develop and lead high performing teams.

• Solid technical skills to include Microsoft Office Suite applications with demonstrated Word, Excel, Access and PowerPoint expertise.

• Demonstrated experience managing healthcare clearinghouse platforms (e.g., Waystar, Change Healthcare, Availity), including EDI 837/835/271/270 transaction management, error resolution, and vendor optimization.

• Proven track record as a change agent with the ability to design and lead transformational initiatives, build organizational buy-in, and sustain measurable improvement in complex, matrixed environments.

Qualifications:

Education:

Bachelor’s Degree in business finance or related field. Substantial professional experience may be considered in lieu of a formal degree.

Experience:

15+ years in finance or revenue cycle management, including demonstrated experience with EDI claims processing, healthcare clearinghouse management (e.g., Waystar, Change Healthcare), and authorization management. Proven history of leading organizational change and process transformation initiatives at scale.

Working Conditions:

Remote with occasional business travel

Supervisory Responsibility (If applicable):

May supervise up to 40 people

Compensation & Benefits:

• 401k Retirement Plan

• Medical, Dental and Vision insurance on first day of employment

• Generous Paid Time Off

• Employee Assistance Program and more

Compensation range: $165,000 - $190,000 annually

This role is eligible for a base salary within the posted range. Actual compensation will be determined based on a variety of factors, including skills, experience, and geographic location. Compensation may vary for positions based in high cost-of-labor markets.

The above is intended to describe the general contents and requirements of work being performed by people assigned to this classification. It is not intended to be construed as an exhaustive statement of all duties, responsibilities, or skills of personnel so classified

Public Partnerships is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PPL, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PPL will not tolerate discrimination or harassment based on any of these characteristics. PPL believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.

If you like wild growth and working with happy, enthusiastic over-achievers, you'll enjoy your career with us!

Originally posted on Himalayas