Position Overview

We are seeking a highly experienced Director of Revenue Cycle Management (RCM) based in South Africa with deep, hands-on experience in US provider-side healthcare billing and insurance reimbursement.

This is a senior operational leadership role responsible for stabilizing, optimizing, and scaling revenue cycle operations for a US-based healthcare organization.

The ideal candidate has direct experience with:

• US commercial insurance

• Medicaid / Managed Medicaid

• In-network and out-of-network reimbursement

• Multi-code billing environments

• Authorization-heavy specialties (e.g., ABA, behavioral health, therapy services)

This is not a maintenance role. We are seeking a transformation leader who can repair underperforming revenue operations, resolve aged A/R, reduce denials, and build durable, scalable systems.

Core Responsibilities

1. Operational Leadership

• Lead end-to-end US revenue cycle operations from intake to cash

• Stabilize underperforming A/R and collections performance

• Resolve historical billing issues and denial backlogs

• Build scalable billing workflows across multiple providers, locations, and payers

• Implement controls to prevent revenue leakage

• Establish daily and weekly operational cadence with measurable KPIs

2. US Insurance & Billing Oversight

• Oversee:

  • Eligibility verification

  • Benefits determination

  • Authorization management

  • CPT / HCPCS coding oversight

  • Claims submission and scrubbing

  • Denials and appeals

  • Patient responsibility collection (copays, coinsurance, deductibles)

• Interpret and operationalize payer contracts

• Improve clean claim rates and reduce preventable denials

• Strengthen payer communication processes

3. A/R & Collections Optimization

• Reduce aged A/R (60/90/120+ buckets)

• Improve net collection rate

• Implement structured denial management workflows

• Establish consistent follow-up cadence for claims and patient balances

• Build reliable patient responsibility collection systems

4. Reporting & Analytics

• Develop actionable RCM dashboards including:

  • A/R aging analysis

  • Denial rate trends

  • Payer performance

  • Net collection rate

  • Authorization lag metrics

• Identify root causes of revenue leakage

• Provide financial and operational insight to US leadership

5. Team & Vendor Management

• Lead South African RCM team members

• Manage US-based and/or offshore billing vendors

• Establish performance metrics and accountability standards

• Conduct performance reviews and training

• Create a culture of operational ownership

6. Systems & Technology

• Work within US EHR and billing platforms (e.g., CentralReach, Kareo, AdvancedMD, Athena, etc.)

• Configure:

  • Authorizations

  • Billing rules

  • Service codes

  • Claims workflows

• Improve system utilization to drive operational efficiency

Required Experience (US-Focused)

• 7+ years provider-side US healthcare revenue cycle experience

• Minimum 3+ years in RCM leadership role

• Direct experience working with:

  • US commercial insurance

  • Medicaid / Managed Care

  • Multi-code therapy billing

• Strong understanding of:

  • CPT codes

  • Authorization structures

  • Coordination of benefits

  • In-network vs out-of-network reimbursement

• Demonstrated success improving:

  • A/R performance

  • Denial reduction

  • Collections rate

• Experience managing offshore billing teams

• Advanced proficiency in US EHR and billing platforms
  

Preferred Experience

• Direct ABA therapy billing experience

• Experience with CentralReach

• Hands-on EHR configuration experience

• Experience rebuilding or transforming a struggling RCM department

Key Success Metrics

• Reduction in 90+ day A/R

• Improvement in net collection rate

• Measurable decrease in preventable denials

• Clean claim rate improvement

• Timely claims submission performance

• Stable and scalable intake-to-cash workflow

• Strong vendor performance management

• Clear, executive-level RCM reporting