Revenue Cycle Manager

Description

The Revenue Cycle Manager is responsible for the oversight and optimization of all revenue cycle functions, including patient registration, billing, coding, accounts receivable management, and collections, ensuring the efficient flow of revenue at Heart of Florida Health Center, a Federally Qualified Health Center (FQHC). This role is critical in supporting our mission to provide comprehensive, accessible, and affordable healthcare services to our diverse patient community. The Revenue Cycle Manager will lead and develop the billing team and will remain focused on enhancing revenue cycle operations and ensuring compliance with FQHC regulations, while maximizing reimbursements across Medicaid, Medicare, private insurance, and other payment sources.

• Oversees and manages the entire revenue cycle process from patient intake through to account resolution.
• Develops, implements, and refines policies and procedures to optimize revenue collection and ensures adherence to federal and state FQHC guidelines.
• Maintains accurate patient records for billing and coding processes and ensures they are in compliance with healthcare regulations.
• Monitors and manages claims submission, ensuring timely and accurate processing for all patient services across Medicaid, Medicare, commercial insurance, and self-pay categories.
• Oversees claims resolution processes, analyzing trends in denials and working with the team to resolve issues promptly.
• Works with the billing team to ensure accurate coding practices, reducing instances of claim rejection and minimizing denials.
• Develop strategies to manage and reduce days in accounts receivable (A/R), tracking A/R performance metrics and identifying improvement areas.
• Answers questions related to coding, insurance, and billing for all internal/external customers.
• Works with finance and front-line teams to streamline collection processes, improving cash flow while maintaining compassionate patient relations.
• Ensures patient billing and collection activities are managed in a patient-centric and compliant manner, assisting patients with payment plan options as needed.
• Generates and reviews financial reports related to revenue cycle performance, including collection rates, denial rates, and A/R days, and present findings to the CFO.
• Uses data insights to forecast revenue projections, identify performance gaps, and implement solutions to improve revenue cycle efficiency.
• Ensures accurate documentation and reporting for audits and performance evaluations, maintaining FQHC compliance standards.
• Manages, mentors, and develops the billing team, fostering a collaborative work environment.
• Provides ongoing training and support to ensure staff members are knowledgeable in FQHC billing regulations, coding practices, and revenue cycle processes.
• Collaborates with other departments, including patient services, finance, and clinical teams, to optimize workflows and enhance revenue outcomes.

Qualifications

• Bachelor’s degree in healthcare administration, Business, Finance, or related field; Master’s preferred.
• Minimum of 5 years of experience in revenue cycle management, healthcare billing, or finance, preferably within an FQHC or community health setting.
• Strong knowledge of Medicaid, Medicare, and private insurance regulations, with experience managing revenue cycles for these payers.
• In-depth knowledge of FQHC-specific billing requirements, state and federal compliance standards, and healthcare reimbursement methodologies.
• Proficiency in using Electronic Health Record (EHR) and Practice Management systems, with strong preference for experience in systems commonly used in FQHCs.
• Excellent analytical skills and experience with financial reporting.
• Strong leadership skills, with a focus on employee engagement, development, and performance improvement.
• Exceptional organizational skills, attention to detail, and the ability to manage multiple tasks efficiently.
• Strong interpersonal and communication skills to effectively liaise between departments and work collaboratively across teams.