Associate Director- Revenue Cycle Hospital Billing

Guidehouse Inc.; San Antonio (TX); On-site; USD 120,000 - 180,000; Full time

Job summary

Guidehouse Inc. in San Antonio, TX seeks an experienced Hospital Billing Associate Director - Revenue Cycle to lead daily hospital billing operations and drive timely, accurate claim submission.

You will oversee staff development, monitor KPIs, manage edits and holds, and collaborate with payers and internal teams to resolve issues while ensuring regulatory compliance. This role focuses on process improvement, performance reporting, and maintaining client service standards in a fast-paced

Responsibilities

• Oversee daily hospital claim billing activities to support timely and accurate submission of clean claims.
• Monitor billing work queues, claim edits, claim holds, and unbilled accounts to identify barriers to submission.
• Ensure billing staff resolve edits or route accounts to correct department when corrections are required.
• Collaborate with payers, clearinghouses, internal departments to resolve recurring billing issues.
• Identify systemic billing issues and develop corrective action plans in partnership with relevant teams.

Job description

Job Family :

PFS General

Travel Required :

None

Clearance Required :

None

The Hospital Billing Associate Director - Revenue Cycle is responsible for overseeing the teams who handle the daily operations of the hospital billing to ensure timely, accurate, and compliant submission of facility claims. This position provides day-to-day leadership and technical guidance to billing staff, monitors billing productivity and quality, manages claim edits and billing holds, and works collaboratively with internal departments and payers to resolve issues that delay claim submission or reimbursement.

The Associate Director is responsible for ensuring established billing goals and client service level expectations are achieved while maintaining compliance with federal, state, payer, and organizational requirements. This position also identifies billing trends, implements process improvements, supports staff development, and communicates operational issues and recommendations to management.

Essential Job Functions

• Hospital Billing Operations
• Staff Leadership, Training, and Development
• Claim Edit and Billing Hold Management
• Billing Quality and Compliance
• Payer Issue Resolution and Escalation
• Productivity and KPI Management
• Reporting and Process Improvement
• Cross-Functional Collaboration

Duties and Responsibilities

Leadership and Staff Management

• Provides daily leadership, direction, coaching, and support to hospital billing staff.
• Promotes a professional, collaborative, and accountable work environment.
• Sets clear expectations for productivity, quality, attendance, and performance.
• Monitors individual and team performance against established operational goals and KPIs.
• Provides ongoing training and education regarding billing requirements, payer updates, regulatory changes, and departmental procedures.
• Identifies employee development opportunities and provides timely coaching and feedback.
• Ensures staff have the tools, training, system access, and operational knowledge necessary to perform their responsibilities successfully.
• Conducts regular team meetings to communicate operational updates, performance results, payer changes, and process improvements.
• Escalates staffing, performance, compliance, and operational concerns to management when appropriate.

Hospital Billing Operations

• Oversees daily hospital claim billing activities to support timely and accurate submission of clean claims.
• Ensures claims are generated, reviewed, corrected, and released according to established billing timelines.
• Monitors billing work queues, claim edits, claim holds, and unbilled accounts to identify barriers to timely claim submission.
• Ensures billing staff appropriately resolve edits or route accounts to the correct department when additional information or correction is required.
• Monitors electronic claim submissions, payer rejections, clearinghouse edits, and billing exceptions through resolution.
• Oversees corrected, replacement, and adjusted claim workflows as appropriate.
• Ensures billing staff accurately document actions taken within the patient accounting system.
• Monitors reconciliation activities to ensure claims released from the patient accounting system have successfully progressed through the billing process.
• Ensures billing issues are researched and resolved timely and appropriately escalated when necessary.
• Works with payers, clearinghouses, internal departments, and other stakeholders to resolve recurring billing issues.
• Identifies systemic billing issues and partners with appropriate departments to develop corrective action plans.

Billing Quality and Revenue Cycle Performance

• Monitors billing accuracy, claim quality, productivity, and timeliness.
• Reviews work queues and operational reports to identify trends, backlogs, aging inventory, and opportunities for improvement.
• Develops action plans to reduce billing delays and prevent avoidable rework.
• Performs or coordinates quality reviews to ensure staff adherence to established billing procedures.
• Identifies root causes of recurring claim edits, rejections, and billing delays and works with appropriate teams to implement sustainable solutions.
• Monitors key billing performance indicators and implements strategies to improve performance.
• Ensures assigned billing inventories are worked according to established prioritization and aging expectations.
• Communicates significant operational trends, barriers, and risks to management.

Payer and Interdepartmental Collaboration

• Serves as an escalation point for complex hospital billing issues.
• Collaborates with Patient Access, Health Information Management, Coding, Utilization Management, Revenue Integrity, IT, and other revenue cycle departments to resolve issues affecting claim generation and submission.
• Partners with payers and clearinghouses to research and resolve recurring claim submission and rejection issues.
• Communicates payer billing changes and requ