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About the Role

UBMD Orthopaedics & Sports Medicine is seeking an experienced and strategic Director of Billing & Revenue to lead all aspects of the organization's physician billing and revenue cycle operations. This role is critical in ensuring accurate reimbursement, regulatory compliance, operational efficiency, and exceptional financial performance across multiple clinical locations and subspecialties.

Responsibilities

Provide strategic leadership and operational oversight of all physician billing and revenue cycle functions.
Develop and execute departmental goals, key performance indicators (KPIs), and performance improvement initiatives aligned with organizational objectives.
Lead billing operations to ensure timely charge entry, clean claim submission, payment posting, collections, denial management, and accounts receivable follow-up.
Oversee billing processes for orthopaedic surgery, sports medicine, physical therapy, imaging, durable medical equipment (DME), and other ancillary services.
Ensure accurate reimbursement for surgical procedures by maintaining expertise in global surgical packages, modifiers, multiple procedure reductions, bundled services, and payer-specific reimbursement methodologies.
Collaborate with Coding leadership to promote accurate CPT, ICD-10-CM, and HCPCS coding, documentation integrity, and compliance with national and payer-specific billing requirements.
Monitor revenue cycle performance through regular analysis of key metrics including Days in Accounts Receivable, Net Collection Rate, First Pass Claim Acceptance Rate, Denial Rate, Bad Debt, Charge Lag, and Payment Variance.
Develop action plans to improve financial performance and operational efficiency based on data analysis and industry benchmarks.
Partner with physicians, team managers, and operational leadership to resolve reimbursement issues, educate providers on documentation opportunities, and improve charge capture processes.
Maintain current knowledge of Medicare, Medicaid, commercial insurance, workers' compensation, no-fault, and value-based reimbursement models.
Oversee payer enrollment, provider credentialing support, contract implementation, reimbursement analysis, and payer issue resolution.
Ensure compliance with all federal, state, and regulatory requirements including HIPAA, CMS guidelines, OIG recommendations, and payer policies.
Lead revenue cycle optimization initiatives, workflow redesign, technology implementations, and system enhancements.
Develop, implement, and maintain departmental policies, procedures, and internal controls.
Prepare executive-level reports and presentations summarizing financial performance, operational metrics, reimbursement trends, and departmental initiatives.
Recruit, mentor, coach, and develop billing leadership and staff while fostering a culture of accountability, collaboration, customer service, and continuous improvement.
Manage departmental budgets, staffing plans, productivity expectations, and vendor relationships.
Collaborate with Finance regarding month-end reconciliation, revenue reporting, and reimbursement forecasting.
Serve as the organization's subject matter expert on physician billing and reimbursement matters.

Requirements

Minimum of 7–10 years of progressive physician billing and revenue cycle management experience.
Minimum of 5 years of leadership experience overseeing physician billing teams.
Demonstrated success improving revenue cycle performance through operational leadership and process improvement.
Prolonged periods of sitting and computer work.
Ability to occasionally stand, walk, bend, and lift up to 20 pounds.
Ability to travel between UBMD Orthopaedics & Sports Medicine locations as needed.

Skills

Extensive knowledge of physician billing, reimbursement methodologies, revenue cycle management, and healthcare financial operations.
Advanced knowledge of orthopaedic surgery billing, global surgical periods, modifier usage, surgical coding concepts, musculoskeletal procedural reimbursement, imaging, physical therapy, DME, and ancillary service billing.
Thorough understanding of Medicare, Medicaid, commercial insurance, workers' compensation, no-fault, and payer contract requirements.
Strong knowledge of CPT, ICD-10-CM, HCPCS Level II, National Correct Coding Initiative (NCCI) edits, and documentation guidelines.
Experience with electronic medical records (EMR), physician practice management systems, clearinghouses, and revenue cycle software.
Exceptional analytical, financial, organizational, and project management skills.
Strong leadership, communication, and relationship-building abilities with physicians, executives, and multidisciplinary teams.
Ability to interpret financial and operational data to drive strategic decision-making.
Demonstrated ability to lead change, improve workflows, and foster a high-performing team environment.
Advanced proficiency in Microsoft Excel and other Microsoft Office applications.

Location

Western New York

Work Type

Office 90% of the time

Experience Level

7-10 years of progressive physician billing and revenue cycle management experience
5 years of leadership experience

Education Level

Bachelor’s degree required
Master's degree preferred
Professional certifications such as Certified Professional Biller (CPB), Certified Professional Coder (CPC), Certified Revenue Cycle Representative (CRCR), or other revenue cycle certification preferred

About the Company

As the largest orthopaedic practice in Western New York, UBMD Orthopaedics & Sports Medicine is committed to delivering exceptional patient care through innovation, collaboration, and clinical excellence.