Director of AR Operations & Revenue Integrity

Description

The Director of AR Operations & Revenue Integrity leads the functions that determine whether the practice collects

every dollar it is owed: payment posting and reconciliation, accounts receivable management, underpayment

recovery, and credit balances and refunds. Working with managed care, compliance, finance, and operational

leadership, this leader builds standardized, scalable processes across a large, multi-location ophthalmology

practice, protects payment integrity, and manages RCM vendors and technology partners.

The ideal candidate is an innovative, collaborative, results-driven leader who understands the complexity of

ophthalmology reimbursement, including medical vs. routine vision coverage, surgical global periods, injectable

drug billing, and diagnostic testing, and who turns that knowledge into measurable financial performance.

RESPONSIBILITIES:

Payment Posting and Reconciliatio n

› Ensure timely, accurate posting of insurance, patient, and lockbox payments, including ERA/EOB and manual

posting.

› Oversee daily deposit reconciliation among bank deposits, clearinghouse and lockbox files, and the PM system in

partnership with Finance and Accounting.

› Establish controls for adjustments, contractual write-offs, payment variances, and unapplied or misapplied cash.

› Monitor payer remittance trends, including recoupments, offsets, and takebacks, and ensure timely and accurate

handling.

Accounts Receivable Management

› Direct strategies for aged A/R reduction, claim follow-up, denial management, and appeals.

› Define work queue prioritization, follow-up cadences, and escalation paths by payer, balance, and aging.

› Partner with Coding, Billing, Credentialing, and Managed Care to resolve payer issues and systemic barriers to

payment.

› Feed denial and payment trends back to front-end, coding, and clinical operations teams to drive upstream

corrective action.

Underpayment Recovery

› Build and oversee a structured program to identify, quantify, and recover underpayments by comparing

payments to contracted rates and fee schedules.

› Partner with Managed Care to maintain accurate contract terms, load fee schedules, and escalate payer contract

compliance issues.

Monitor reimbursement for high-volume ophthalmology services, including cataract surgery, diagnostic testing,

intravitreal injections, and injectable drugs.

› Track recovery rates, payer-specific trends, and the financial impact of underpayment findings, and report results

to executive leadership.

Credit Balances and Refunds

› Oversee the identification, review, and timely resolution of insurance and patient credit balances.

› Ensure refunds and payer overpayment returns are accurate, properly approved, and processed within

regulatory and payer timelines.

› Maintain compliance with Medicare and Medicaid overpayment return rules, payer-specific refund policies, and

unclaimed property (escheatment) obligations.

› Analyze root causes of credits, such as duplicate payments, coordination of benefits issues, posting errors, and

incorrect contractual adjustments, and drive prevention.

Revenue and Payment Integrity

› Ensure payments, adjustments, and write-offs are accurate, supported, and compliant, with internal controls and

audit routines for posting, adjustments, refunds, and write-off approvals.

› Partner with Coding, Compliance, and Revenue Cycle leaders to share audit findings, payer policy changes, and

denial and underpayment insights.

› Partner with Compliance on overpayment investigations, self-disclosure considerations, and corrective action

plans.

Standardization, KPIs, and Performance Improvement

› Develop, document, and maintain standard operating procedures and best practices for posting, A/R follow-up,

underpayment recovery, and refunds across all locations.

› Define, track, and report KPIs, including days in A/R, A/R aging (% over 90 and 120 days), net and gross

collection rate, posting accuracy and lag, unapplied cash, denial overturn rate, underpayment recovery rate,

credit balance aging,and refund turnaround time.

› Build dashboards and scorecards for leadership, analyze trends by payer, location, provider, and service line, and

hold teams accountable to targets.

› Lead continuous improvement initiatives using data analysis, automation, and lean/process improvement

methodologies.

› Identify and pilot innovative solutions, including Robotic Process Automation (RPA), AI-assisted workflows, and

advanced analytics, to improve accuracy, productivity, and cost to collect.

Vendor and Technology Management

› Manage relationships, contracts, SLAs, and performance of RCM vendors, including clearinghouses, lockbox

providers, underpayment recovery partners, payment processors, outsourced A/R partners, and

refund/escheatment service providers.

› Evaluate vendors and tools, lead RFPs, and recommend decisions based on performance and ROI.

› Partner with IT and system owners on PM/EHR optimization, configuration, upgrades, and reporting

Leadership and Compliance

› Lead, coach, and develop a high-performing team, setting clear goals and fostering a culture of accountability

and collaboration.

REQUIREMENTS:

› Bachelor's degree in Healthcare Administration, Business, Finance, Accounting, or a related field, or equivalent

experience.

› 8+ years of progressive revenue cycle experience, including 4+ years in a management or director-level role.

› Deep, hands-on knowledge of payment posting, A/R management, denial management, underpayment recovery,

and credit balance and refund processes.

› Working knowledge of payer contracts, reimbursement methodologies, and regulatory requirements for

overpayment refunds.

› Demonstrated experience leading multi-site operations in a large physician group, specialty practice, or MSO.

› Proven track record of building standardized processes, improving KPIs, and delivering measurable financial

results.

› Experience managing vendors and contracts.

› Strong analytical skills and proficiency in reporting and dashboard tools (Excel, Power BI, Tableau, or similar).

› Excellent communication, leadership, and stakeholder management skills.

Preferred

› Ophthalmology or other surgical/procedural specialty experience, including injectable drug and medical/vision

plan billing.

› Experience building or managing an underpayment recovery or contract compliance program.

› Experience with practice acquisitions and system integrations/conversions.

› Experience with ophthalmology-specific PM/EHR platforms (e.g., Nextech, ModMed, Compulink, Epic, or similar).

› Certification such as CRCR, CPC, CPMA, or CHFP; Lean Six Sigma.

› Experience with automation, AI-enabled tools, or RCM technology implementations.

› Private equity-backed or high-growth practice environment experience.