Director of Revenue Cycle

The Director of Revenue Cycle manages all functions of the organization's billing and revenue cycle to maximize cash flow while maintaining and improving internal and external customer relations. In conjunction with the Chief Financial Officer (CFO), the Director of Revenue Cycle will contribute to the day-to-day operations on all issues related to the revenue cycle function, provide analysis, create written processes, and train others in implementing a cross-functional revenue cycle.

The role ensures that revenue cycle operations are efficient, compliant with regulations and aligned with the organization's financial goals, particularly within the unique environment of a Federally Qualified Health Center (FQHC). The Director of Revenue Cycle is responsible for working closely with all Revenue Cycle disciplinary teams, including, but not limited to, registration, prior authorization, reimbursement, coding, billing, denials, and patient accounts.

• Manage all functions of FHC’s billing and revenue cycle to maximize cash flow.
• Developing and leading a high performing and engaged revenue cycle team.
• Aligning revenue cycle team with organizational strategic priorities and maintaining a strong focus on their engagement and accountability.
• Streamlining revenue cycle processes and systems (currently EPIC and Dentrix).
• Provide analysis and create written processes for the revenue cycle.
• Overseeing A/R reporting functions, ensuring accurate and timely analysis, overseeing third-party claims processing, reimbursement, denials, appeals, and collections.
• Working with the finance department in cash reconciliation and month-end reporting.
• Running financial reports, analyzing, and interpreting data, and assisting in implementation and maintenance of electronic claim submission and posting systems.
• Developing and implementing the departmental annual strategic work plan.
• Ensuring FQHC providers receive appropriate education and feedback.
• Assisting in quality improvement activities as related to revenue cycle.
• Participating with matters related to regulatory compliance, analysis, and cost reporting functions.
• Maintaining a working knowledge of FQHC, CMS, HRSA, Medicare PPS, Medicaid, and other applicable billing and compliance rules and regulations.
• Becoming subject matter expertise in FQHC / CHC billing and HRSA policies.
• Reviewing sliding fees and fee schedules to ensure the schedules are current.
• Participating in annual financial audit.
• Preparing annual billing and compliance audit plan.

Qualifications:

• Master’s degree in Health Administration, Business Administration, Finance, or a related field; equivalent experience may be considered.

• 5–10 years of progressively responsible leadership in revenue cycle management, preferably in a healthcare or FQHC setting.

• Strong financial analysis skills and deep understanding of private and governmental payer systems, including eligibility, charge capture, coding, billing, and collections.

• Proficiency in CPT coding and maintenance, payment posting, and self-pay processes.

• Solid grasp of healthcare finance and accounting principles, with practical experience in clinical operations and revenue cycle management.

• Familiarity with CHAMPS, FQHC billing requirements, MDHHS Medicare cost reporting, and compliance regulations including the Anti-Kickback Statute, False Claims Act, and Stark Law.

• CPC or Certified Revenue Cycle Executive certification preferred.

• Experience with Epic is strongly preferred.