Senior Director, Revenue Cycle Management

About The Oncology Institute (www.theoncologyinstitute.com): 
Founded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI offers cutting-edge, evidence-based cancer care to a population of approximately 1.9 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With over 180 employed and affiliate clinicians and over 100 clinics and affiliate locations of care across five states and growing, TOI is changing oncology for the better. 

At The Oncology Institute, the Senior Director of Revenue Cycle Management is more than a financial leader—you are a catalyst for sustainable healthcare delivery. We empower you to shape enterprise-wide revenue strategy, modernize RCM operations, and lead high-impact teams that directly support patient access and organizational growth. You will have the autonomy and executive partnership to drive transformation across the full revenue cycle, leverage advanced analytics and technology, and influence decisions at the highest levels. We value your expertise and trust your judgment, offering the resources, visibility, and support needed to deliver measurable results in a complex regulatory environment.

Role Summary

The Senior Director of Revenue Cycle Management (RCM) provides enterprise leadership for all non‑patient‑facing revenue cycle operations. This role sets strategy, standardizes processes, and drives performance excellence across eligibility and benefits verification, prior authorizations, billing, payment posting, accounts receivable follow‑up, self‑pay management, credit balance resolution/refunds, and provider credentialing/enrollment. The Executive Director is accountable for cash acceleration, denial prevention, regulatory compliance, and a best‑in‑class cost‑to‑collect while enabling access to care through timely, accurate financial clearance and payer readiness.

Key Responsibilities

Strategy, Leadership & Governance

• Build and execute the multi‑year RCM strategy for non‑patient‑facing functions; translate goals into annual operating plans, budgets, staffing models, and technology roadmaps.
• Lead, mentor, and develop a multi‑site leadership team; establish clear accountability, succession pipelines, and competency‑based training.
• Own RCM policies/SOPs, internal controls, and audit cadence to ensure standard work, scalability, and risk mitigation across all markets.

Eligibility & Benefits Verification

• Ensure accurate payer/plan capture, coordination of benefits (COB), and benefit calculations to enable clean claims and point‑of‑service collections.
• Set and monitor lead‑time targets (e.g., verification ≥7 days ahead of service when applicable), accuracy thresholds, and timeliness SLAs.
• Drive automation (270/271), payer portal/API use, and exception‑based workflows; reduce eligibility‑related rejections/denials.

Central Authorizations (Medical Necessity & Utilization Requirements)

• Oversee end‑to‑end prior authorization operations (including 278 transactions, clinical documentation routing, and peer‑to‑peer escalations).
• Optimize turnaround time (TAT) and first‑pass authorization rates; minimize avoidable write‑offs due to missing/expired auth or site‑of‑service requirements.
• Partner with clinical and contracting teams to align on coverage policies, medical necessity criteria, and payer rule changes.

Billing & Claim Submission

• Achieve high clean claim rates through robust edits, charge capture reconciliation, correct payer selection, and coding integrity (with Coding/Compliance partners).
• Standardize clearinghouse workflows (837/835), claim status (276/277), and error correction queues; reduce avoidable rework and paper handling.

Payment Posting & Revenue Assurance

• Ensure timely and accurate cash posting, remit reconciliation, and denial code integrity to support downstream AR analytics and appeals.
• Expand ERA/EFT adoption and auto‑posting; establish posting timeliness SLAs (e.g., 24–48 hours of receipt) and suspense/exception resolution targets.
• Implement root‑cause analysis for underpayments/recoupments; coordinate contract modeling and recovery with Payer Relations/Managed Care.

Accounts Receivable, Self‑Pay & Credit Balances

• Own enterprise AR performance (insurance & patient); reduce AR days and >90/120‑day inventory via disciplined worklists and segmentation.
• Lead self‑pay strategy (statement cadence, early‑out/vendor oversight, payment plans, financial assistance screening) to improve self‑pay yield while ensuring a positive patient financial experience.
• Govern credit balance research and timely, compliant refunds; prevent re‑issuance and rebilling errors via strong upstream controls.

Credentialing & Provider Enrollment

• Oversee payer enrollment, revalidation, and re‑credentialing cycles; maintain on‑time, error‑free submissions to avoid cash disruption.
• Standardize privileging coordination with Medical Staff Services; manage third‑party credentialing vendors as applicable with clear SLAs and QA.

Analytics, Automation & Continuous Improvement

• Build a performance management system (dashboards, scorecards, daily management) for each function; use leading indicators to drive proactive interventions.
• Champion automation/RPA, NLP/AI‑assisted denial prediction, and digital intake for authorizations and eligibility; scale exception‑based workflows.
• Run Kaizen/Lean events; institutionalize root‑cause/Corrective & Preventive Action (CAPA) practices.

Compliance & Risk

• Ensure compliance with HIPAA, CMS, OIG, state regulations, balance‑billing prohibitions, No Surprises Act (GFE/AEOB), payer policies, and refund regulations.
• Partner with Compliance, Privacy, and Internal Audit on controls, documentation, and corrective actions.

Cross‑Functional Partnership

• Collaborate with Patient Access/Clinic Operations, Coding/Documentation Integrity, Payer Contracting, Finance/Accounting, IT/PMO, and Legal/Compliance.
• Provide executive‑ready insights and recommendations to leadership; represent RCM in enterprise initiatives and payer‑related escalations.

Success Metrics (KPIs & Targets)

(Final targets to be aligned with Finance and enterprise goals.)

• Cash & Collections: Net collection rate; cash to goal; cost‑to‑collect.
• AR Health: Total AR Days; >90/120‑day AR %; denial inventory aging.
• Clean Claim Performance: First‑pass acceptance rate; claim rejection rate; DNFB/DNFC backlogs.
• Denials: Initial denial rate; preventable denial rate; appeal overturn %; denial write‑off %.
• Posting & Refunds: Payment posting timeliness; unapplied cash; refund aging; credit balance backlog and cycle time.
• Eligibility & Auth: Eligibility accuracy %, verification lead‑time adherence; authorization TAT; auth‑related denial rate.
• Self‑Pay: Self‑pay yield; bad‑debt %; payment plan adherence; early‑out vendor recovery vs. target.
• Credentialing/Enrollment: Cycle‑time from provider onboarding to first claim paid; re‑credentialing on‑time rate; enrollment error rate.
• People & Quality: Leadership bench/succession readiness; employee engagement; QA audit pass rates.

Qualifications

• 10+ years progressive leadership in healthcare revenue cycle; 5+ years leading multi‑function, multi‑site teams across billing, AR, and financial clearance.
• Deep expertise in both FFS and risk/capitated environments; strong payer rules knowledge and contract/underpayment acumen.
• Demonstrated success implementing RCM technology (EHR/PM, clearinghouse, ERA/EFT, prior auth/eligibility transactions 270/271, 276/277, 278) and analytics (BI dashboards).
• Proven vendor governance experience (e.g., early‑out, bad‑debt, denial management, offshore/BPO, credentialing).
• Strong command of revenue integrity, denial prevention, and compliance frameworks (HIPAA, CMS, OIG, NSA/GFE).
• Exceptional leadership, change management, and communication skills; track record of culture‑building and talent development.
• Education: Bachelor’s degree required; Master’s in healthcare, business, or related field preferred.
• Certifications (preferred): HFMA CRCR/CHFP; AAPC CPC/CPCO or equivalent; NAMSS CPCS/CPMSM for credentialing oversight.

Leadership Competencies

• Enterprise Thinking: Connects local operations to system‑level financial and patient access outcomes.
• Operational Excellence: Simplifies processes, standardizes work, and uses data to make timely decisions.
• Tech‑Forward Mindset: Pragmatically applies automation/AI and integrates with existing platforms.
• Vendor Stewardship: Sets clear SLAs, quality controls, and ROI metrics; course‑corrects quickly.
• People‑First: Coaches, recognizes, and retains high performers; builds resilient teams through change.

Working Conditions

• Occasional evening/weekend work for cutovers and month‑end close.
• Travel: ~10–25% to sites, vendors, and payer meetings.

30/60/90‑Day Expectations (optional to include in posting; useful for onboarding)

• 30 Days: Assess team structure, SOPs, vendor contracts, dashboards; confirm KPI baseline; identify quick wins to accelerate cash/posting and reduce denials.
• 60 Days: Implement a weekly executive scorecard; launch top‑3 denial prevention fixes; tighten posting timeliness and refund aging controls.
• 90 Days: Present a 12‑month roadmap covering automation, organizational design, vendor optimization, and contract/underpayment strategy with quantified ROI.