We are a new and growing value-based care healthcare organization with a unique and innovative approach to healthcare. Our mission is to improve lives and communities through socially supported primary care for older adults. Our innovative business model allows our clinicians to treat the whole patient - not just their clinical needs. We do this by having a dedicated care team that supports our clinicians by addressing our patients’ social determinants of health and providing the highest quality of service possible. Our ultimate vision is creating generational health and equity for communities across the country, one patient at a time.

Summary of the role:

We are seeking a Director of Revenue Cycle to oversee both front end and back-end revenue cycle operations, ensuring that we are billing and collecting efficiently and in a compliant manner. Reporting to our Head of Finance, you will collaborate with providers, payers, operational teams, and executive leadership while building our revenue cycle infrastructure for future growth. You will lead our billing team and help define the strategy for building out our Revenue Cycle function as the organization grows. You will define and implement processes to report on and manage our overall revenue cycle performance to ensure that we are enhancing overall financial performance while optimizing patient experience.

This position offers remote work with occasional on-site visits as needed.

Key Responsibilities:

Revenue Optimization: Oversee the complete revenue lifecycle from insurance verification to billing procedures, coding accuracy, reimbursement strategies, and collection efforts to maximize timely revenue capture and minimize payment delays.
Infrastructure and compliance: Establish frameworks and protocols that accommodate organizational expansion while maintaining strict adherence to healthcare compliance requirements including HIPAA, coding integrity, and billing standards.
Analytics: Establish reporting to monitor critical performance measures to assess revenue cycle effectiveness, pinpoint improvement opportunities, and foster operational excellence. Conduct data-driven analyses on revenue patterns and performance indicators to deliver comprehensive insights for leadership decision-making.
Cross-functional partnership: Partner with departmental stakeholders to design and execute streamlined processes for critical revenue functions including patient onboarding, insurance verification, eligibility determination, financial counseling, authorization management, claims submission, payment reconciliation, and account resolution.
Payer Engagement: Cultivate strategic relationships with insurance partners to maintain effective communication channels regarding contract execution, fee adjustments, information exchange, and other collaborative initiatives.
Credentialing: Own the entire credentialing process to ensure providers can efficiently bill with each of our payor partners.
Regulatory Oversight: Remain current on evolving healthcare legislation and ensure all revenue activities maintain strict compliance with regulatory requirements to reduce exposure to audit scrutiny and potential penalties.
Team Development: Develop and guide a talented revenue cycle team, providing professional development, skills training, and performance feedback to drive continuous improvement in operational capabilities.
Additional Responsibilities: Fulfill other related duties as required to ensure a seamless and efficient revenue cycle operation.

Requirements:

MUST HAVE: Experience with Athena EHR
MUST HAVE: Demonstrated expertise in value-based care models, preferably in a primary care setting
MUST HAVE: Prior experience in a startup environment
Strong command of healthcare reimbursement structures and payment methodologies
Exceptional analytical capabilities, communication skills, and leadership presence
Minimum of four years of revenue cycle experience in a professional setting, preferably in a leadership role
A broad understanding of all areasrevenue cycle management
Experience managing a team of revenue cycle professionals
Familiarity with Medicare and Medicare Advantage reimbursement dynamics and regulations
Knowledge of the ICD-10, CPT-/HCPCS universal coding systems, and general medical terminology
Certified Professional Coder certification or equivalent

Why Join Gather Health

We are a mission-based organization that is passionate about changing the way seniors experience primary care
Our business model is unique and on the cutting-edge of the primary care industry
Our leadership team is comprised of experienced individuals who are committed to creating not only the best patient experience, but also an amazing employee experience for our colleagues
We are intentionally building a strong company culture and providing a compassionate and joyful work environment
The organization was conceptualized, founded, and launched by experienced co-founders with a track record of success in the healthcare space

We offer competitive pay and benefits for our Full-Time colleagues, including:

Market-based base salaries
Paid Time Off (total of 3 weeks per year PTO that accrues with each pay period)
11 Paid Holidays
Medical insurance coverage (health, dental, vision) with no waiting period for enrollment
Short and Long-Term disability insurance at no cost to you
Basic life insurance coverage at no cost to you
401K with $1 for $1 match up to 4% of income
Employee Assistance Program at no cost to you
Supplemental benefits available for discounted prices

Gather Health is an Equal Opportunity Employer. All employment decisions are made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, or any other basis as protected by federal, state, or local law.

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