Manager, Patient Financial Services

Title:  Manager, Patient Financial Services   

Reports to:  VP, Credentialing and Billing

Classification:  Manager

Location: Boston (Hybrid)

Job description revision number and date: V: 3.0; 04.07.2025

Organization Summary:

Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices in Massachusetts and across the country.  We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary:

This position provides leadership and oversight to the billing and accounts receivable activities for our FQHCs that are on our instance of Epic in our Share Services model.  The ideal candidate will lead and manage a team of revenue cycle resources, ensuring compliance with state and federal guidelines, optimize revenue cycle performance, and provide strategic support to both C3 and our FQHCs financial goals.  The Billing Manager should have a background in FQHC billing requirements, proficiency in using Epic, and a solid understanding of healthcare billing regulations, particularly in Massachusetts. 

Responsibilities:

·       Supervise and mentor the billing team and AR teams, providing training and support to maintain high standards of accuracy and productivity

·       Facilitates positive collaboration with other leaders within the MSO, across C3, and at the Health Centers

·       Conduct regular performance reviews and address performance issues promptly

·       Foster a collaborative and professional team environment

·       Stay updated on billing codes, payer requirements, and policy changes

·       Establishes, updates, and maintains policies and procedures governing billing and collections, ensuring the documentation is always current, complete, and user-friendly

·       Identifies process and technology improvements to improve the effectiveness and efficiency of revenue cycle operations. Collaborates with internal and external constituents to execute improvements

·       Help create the vision for C3 to be the go-to resource for an affordable and efficient MSO in Billing and credentialing

·       Oversee daily billing operations for the FQHC(s), ensuring accurate and timely processing of claims

·       Monitor and analyze billing processes to identify areas for improvement and implement solutions

·       Ensures daily reconciliation of claims transmitted to claims acceptance is completed in a timely manner

·       Manage accounts receivable, ensuring collections are optimized and follow-up processes are timely and efficient

·       Utilize and build Epic WQs to best manage and segment the assigned work to team members to ensure productivity standards are met and all AR is managed timely

·       Regularly completes denial management trending and root cause analysis tom implement denial prevention strategies

·       Serve as the primary point of contact for EPIC-related billing processes and configurations

·       Ensure optimal utilization of the EPIC system to streamline workflows and enhance billing and AR  efficiency

·       Collaborate with IT and EPIC support (CTC) teams to resolve technical issues and implement system updates

·       Follow ticket management processes and criteria when needing technical system support or updates

·       Prepare and present regular reports on revenue cycle performance, billing metrics, key performance indicators (KPIs), and trends

·       Prepares month end results reporting packages

·       Define and meets/exceeds AR management and cash collections goals

·       Analyze data to identify opportunities for revenue growth and process enhancements

·       Develop and implement strategies to reduce denials and improve collections

·       Ensure all billing activities comply with state and federal regulations, including those specific to FQHCs and Massachusetts healthcare laws

·       Maintain knowledge of Medicaid, Medicare, and commercial insurance policies applicable to FQHCs

·       Work closely with clinical, administrative, and finance teams to ensure alignment on billing/AR practices and revenue goals

·       Works closely with vendors and other third parties to facilitate timely and accurate data capture and collections

·       Represent the billing department in audits, meetings, and organizational planning sessions

·       Consistently provide service excellence to all patients, family members, visitors, volunteers, and co-workers in a manner that reflects C3’s mission and core values

Required Skills:

·       Proficiency with Epic systems, including configuration and reporting

·       Strong knowledge of Massachusetts healthcare billing regulations and payer requirements

·       Strong leadership, excellent communication skills across stakeholders, attention to detail, and problem-solving skills

·       Results driven and outcome focused

·       Must be innovative, comfortable with ambiguity, well-organized, and committed to moving quickly and collaboratively in the context of a rapidly changing organization

·       Experience with quality improvement/change management and project management

·       Proficiency in Microsoft Office Suite

·       Must have a strong commitment to quality assurance and exceptional customer service

·       A strong commitment to the organization’s mission

Desired Other Skills:

·       Certification in medical billing or coding (e.g., CRCR, CPC, CPB) is a plus

·       Epic certification in charge router, professional billing/Resolute, or other Epic EHR functionality

·       Familiarity with the MassHealth ACO program

·       Experience working in Federally Qualified Health Centers (FQHC)

·       Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Qualifications:

·       Bachelor’s degree in healthcare administration, business, finance, or a related field preferred

·       A minimum of 5 years of experience in healthcare billing, with at least 2 years in a managerial role

** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **