Senior Director, Ambulatory Services and PB Operations

Summary:

The role is a senior, hands-on operational leader who embeds with a large health system client to drive transformation across ambulatory and professional billing (PB) operations. The role is paired seatfor-seat with the client leader accountable for the same functional area - two in the box, one roadmap, one number - and owns the area’s initiatives end-to-end: scheduling and access, charge capture, professional coding, HIM, and CDI, from future-state design through Epic build, activation, adoption, and validated financial value.

This is an operator’s role, not an advisory one. The Ambulatory Lead works in the client’s Epic environment, alongside clinic, coding, and PB teams, to change how the operation performs: reducing charge lag and late charges, lowering PB coding denials, improving provider utilization and template yield, and standing up the CDI and coding measurement that drives documentation and reimbursement. Success is measured in the client’s own reporting and signed off by the client’s Finance team, not in recommendations delivered.

The right candidate brings the pattern library of what top-quartile ambulatory, and PB performance looks like, the Epic depth to direct build and testing, and the credibility to lead physician practice, coding, and HIM leaders through change. This is a high-visibility seat on a compact, senior transformation team, with direct executive exposure at the client and a clear path into senior consulting and operations leadership at Healthrise.

Duties and Responsibilities:

Ambulatory & PB Transformation Leadership

• Knows, understands, incorporates, and demonstrates the Healthrise Core Values in all interactions with team members, clients, and stakeholders.

• Serve as the Healthrise counterpart to the client’s ambulatory, PB, and revenue integrity leaders, coowning a single integrated plan, one set of KPIs, and one financial target for the area.

• Lead ambulatory and PB initiatives end to end – future-state design, Epic build, testing, activation, adoption, and validated value – rather than handing recommendations to others to implement.

• Diagnose performance using client data (charge lag, PB coding denial rate, pre-A/R days, PB net collection ratio, provider utilization) and convert findings into baselined, sized, owner-assigned initiatives with quarterly gates.

• Work alongside client managers, coders, and frontline staff in daily operations and work queues to close gaps and restore throughput.

• Partner with the Transformation Program Lead and the other paired leads to sequence crossfunctional dependencies (for example, a front-end access fix that is also a PFS denial fix).

Access, Scheduling & Clinic Operations

• Redesign scheduling, provider templates, and order-intake/call center workflows to improve provider utilization and template and scheduling yield.

• Drive adoption of digital access, including patient self-scheduling and pre-registration, and reverse declining utilization of tools the client has already purchased.

• Improve clinic-level access and front-desk workflows, registration accuracy, and point-of-service collection practices in partnership with clinic and patient access leadership.

• Align ambulatory access processes with front-end revenue cycle functions (eligibility, authorization, estimates) so root causes are fixed upstream.

Charge Capture, Coding & PB Billing

• Reduce PB charge lag and late charges by identifying root causes, closing charge capture gaps, and partnering with Revenue Integrity on charge routing, CDM governance, and clinical-trigger capture.

• Lead initiatives to reduce PB coding denials and DNFB, including early documentation, coding gap closure, pre-submission coding compliance, and claim edit optimization.

• Drive adoption of automated and AI-assisted coding (PB coding assistants, computer-assisted and autonomous coding) and support build-versus-buy-versus-adopt decisions against existing coding vendors.

• Improve complex PB billing workflows such as global billing and specialty-specific billing (for example, oral surgery) so claims are accurate and timely at first pass.

• Stand up coding quality programs, including audits, provider education, and error-pattern feedback loops that reduce rework.

HIM & CDI Leadership

• Lead CDI measurement and strategy, including the build-out of case mix index, coverage, and query metrics, and the reporting needed to hold CDI and coding owners accountable.

• Partner with coding, CDI, HIM, and compliance leaders on DRG validation strategy, documentation improvement, and outpatient automated coding expansion.

• Optimize HIM and coding workflows, including backlog management and documentation completeness, to shorten time from service to clean claim.

Epic Optimization & Adoption

• Direct Epic design, prioritization, and validation for ambulatory and PB workflows across scheduling, professional billing, charge capture, coding, HIM, and CDI, and direct build and testing performed by Epic technical analysts.

• Translate operational requirements into Epic build specifications, test scripts, training curricula, tip sheets, and at-the-elbow support plans; lead hypercare through stabilization against defined exit criteria.

• Sequence activations to the client’s Epic version and upgrade calendar and measure adoption by what is utilized, not merely configured.

• Identify and activate Epic-native automation and AI capabilities within scope, with a baseline and hours-and-dollars target for each.

Value Realization, Governance & Knowledge Transfer

• Develop initiative charters and business cases with baseline, target, ramp, and validation method; post benefits to a single validated ledger with client Finance and avoid double-counting across initiatives.

• Present progress, risks, and decisions at weekly pair reviews, monthly executive performance reviews, and quarterly business reviews.

• Lead change management embedded in every initiative: sponsor cascades, super-user networks, communication plans, and adoption measurement.

• Mentor and coach client leaders and staff, and leave behind documented workflows, SOPs, dashboards, and performance history so the client can sustain results independently.

• Ensure all work complies with federal and state billing regulations, HIPAA, CMS and payer policies, coding guidelines, and client standards.

• Performs other duties as assigned.

Required:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or a related field; or equivalent combination of education and progressive experience.

• Minimum 10 years of progressive ambulatory and professional billing revenue cycle experience, including at least 5 years in a senior operational leadership role (director level or above) within a large health system, academic medical center, or multi-site physician enterprise.

• Demonstrated record of directly leading operational transformation and owning measurable outcomes (for example, reduced charge lag, lower coding denials, improved net collection ratio) – not solely advising or recommending.

• Hands-on Epic expertise in ambulatory and PB, including scheduling and access, professional billing, charge capture, coding, HIM, and CDI workflows, with the ability to direct design, build prioritization, testing, and activation.

• Deep working knowledge of PB charge capture, CPT, ICD-10-CM, HCPCS, E/M and modifier rules, CMS guidelines, and payer billing policies, with proven ability to root-cause coding denials.

• Working knowledge of HIM and CDI operations, including documentation improvement, query management, CMI, and DRG validation.

• Experience leading and influencing directors, managers, physicians, and cross-functional teams across large, complex organizations.

• Strong analytical skills: ability to interpret operational and financial data, benchmark against HFMA MAP Keys-aligned standards, and translate findings into prioritized action plans.

• Exceptional written and verbal communication skills; comfortable presenting to executive leadership, clinical leaders, and frontline staff.

• Proficiency in Microsoft Office (Outlook, Word, PowerPoint, Excel).

• Completion of regulatory/mandatory certifications as required.

• Willingness and ability to travel to client or organizational sites as needed.

Preferred:

• Master’s degree (MHA, MBA, or equivalent).

• Epic certification(s) in relevant ambulatory/PB modules (for example, Cadence, Prelude, Resolute Professional Billing, or HIM/coding applications).

• Certified Professional Coder (CPC), Certified Coding Specialist (CCS), CDIP, CCDS, RHIA, Certified Revenue Cycle Professional (CRCP), HFMA Fellow (FHFMA), or equivalent industry certification.

• Lean Six Sigma Green Belt or Black Belt; experience facilitating rapid improvement events and rootcause workshops.

• Experience with AI and automation applied to coding, CDI, charge capture, or claim editing.

• Experience in an academic medical center, faculty practice plan, or safety-net health system.

• Prior consulting, managed services, or embedded-leadership experience supporting multiple client organizations.

• Experience building initiative business cases validated by Finance, including benefits ledgers and glidepath tracking.

• Familiarity with the No Surprises Act, price transparency requirements, and other regulatory developments affecting physician billing.