Director of Revenue Cycle Management

Athena Configuration & Payer Alignment

• Serve as the primary internal owner of Athena claim edit rules, hold queues, and workflow configuration as they relate to our non-FFS billing model.
• Partner directly with Athena's professional services / support team to build and maintain custom rules that suppress inappropriate low-dollar (“penny claim”) edits and prevent unwanted allowable-amount or co-insurance recalculation on contracts where the full billed amount is the contracted rate.
• Translate payer contract terms (rate structures, encounter-reporting requirements, invoicing arrangements) into correct system configuration.
• Maintain a living documentation set of every custom rule, workaround, and configuration decision made in Athena, including rationale and payer applicability.

Claims Operations & Oversight

• Ensure claims are reaching payers as intended and reconcile discrepancies between what was submitted, what was accepted, and what was paid or invoiced.
• Identify and clear inappropriate Athena holds; distinguish true data/coding issues from false positives generated by FFS-oriented logic.
• Track and resolve partial payments, particularly where Athena's allowable-amount logic conflicts with contracted full-payment terms.
• Oversee the separate plan-invoicing process for encounter/penny-claim arrangements, ensuring invoices reconcile against submitted encounters.

Reporting & Analysis

• Design and maintain recurring reports covering: claim submission status, current holds and aging, partial payment / underpayment tracking, and payer-specific exception trends.
• Direct and review the work of the Billing & Claims Analyst in building and running these reports.
• Surface patterns (e.g., a hold type recurring across many claims for one payer) and use them to drive systemic fixes rather than one-off corrections.

Strategic Recommendations

• Lead a structured 90-day assessment of Athena's fit for our billing model (see companion scoping document) and deliver a clear recommendation: continue to mitigate within Athena, or scope a transition to an alternative platform.
• If migration is recommended, lead requirements-gathering and RFP scoping for a replacement EMR/RCM system suited to delegated/value-based billing models.
• Proactively bring forward recommendations — process changes, payer conversations, system configuration, or staffing — rather than waiting to be asked.

REQUIRED QUALIFICATIONS

• 6+ years of revenue cycle management or claims operations experience in healthcare.
• Direct, hands-on experience with value-based care, risk adjustment, HEDIS/quality gap closure, delegated services, or other non-fee-for-service payer arrangements — 
• Practical experience configuring Athena (or a comparable EMR/RCM platform), including working with vendor support/professional services teams on custom edit rules and workflow changes.
• Ability to read and interpret payer contract language and translate contractual terms into system requirements.
• Strong analytical and reporting skills; comfortable building reconciliation reports and communicating findings to finance leadership.
• Demonstrated ability to work cross-functionally with finance, operations, and external vendor teams, and to advocate persistently when a vendor's default assumptions don't fit the business model.

PREFERRED QUALIFICATIONS

• Prior experience evaluating or migrating between EMR/RCM platforms.
• Familiarity with encounter data reporting standards and delegated/capitated payer relationships.
• Certification such as CRCR (Certified Revenue Cycle Representative) or equivalent.
• Experience managing or mentoring junior billing/claims staff.

COMPENSATION & BENEFITS

Competitive wage and benefits package.

Opportunities for professional growth and continuing education.

A supportive, collaborative work environment.