Revenue Cycle Director

Job Title : Revenue Cycle Director

Reports to : Chief Financial Officer

Department : Finance

FLSA Class : Exempt

Updated : January 2025

Summary : The Revenue Cycle Director ("RCD") is responsible for leading revenue cycle operations for all services at Hunter Health Clinic (HHC). The RCM will oversee the billing & accounts receivable functions to ensure timely collection of all patient claims, insurance revenue and program revenue. The RCM functions in accordance with established federal, state, and clinic standards, while complying with all federal grants and HHC policies and procedures.

Essential Functions :

• Leads the revenue cycle staff, including hiring, providing guidance and direction, training, evaluating performance, and initiating corrective action or disciplinary action.
• Develops, implements, and oversees effective billing and collection procedures, including coding, billing, payment posting, collections and denial management.
• Establishes accountability systems and controls to ensure sound practices according to standards and benchmarks set by the organization, licensing boards and funding agencies.
• Demonstrates the ability to analyze data, establish baselines and targets, identify problem areas, and implement improvement initiatives.
• Manages the configuration of all electronic billing systems to ensure proper functioning for effective and efficient billing and collection processes.
• Ensures the timely submission of all claims to third party payers for payment.
• Maintains fee schedule for each service area.
• Provides technical expertise to ensure accurate billing including billing for new services and staying informed of regulatory, compliance and best practices for FQHC billing.
• Maintains responsibility for organization compliance with federal, state, and local legislation pertaining to areas under span of control.
• Ensures timely monthly close of the billing function and prepares end of month management reports.
• Reviews and recommends provider insurance plan network participation agreements.
• Coordinates and manages the practitioner insurance empanelment process.
• Maintains and manages all application registrations and periodic reporting for HRSA (UDS) and CMS (Medicare and Medicaid).
• Develops and maintains department budgets, ensuring appropriate allocation of resources available to meet the business and clinic needs.
• Travels when necessary to meet operational needs.
• Performs all other duties as assigned.

Qualifications :

Physical and Mental Demands of the Job :

All employees, including those who become disabled, must be able to perform the essential job function listed below, either unaided or with the assistance of a reasonable accommodation. The functions listed below are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or a logical assignment to the position. This essential functions document does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. This is not an exhaustive list of all duties and responsibilities associated with this job. Hunter Health Clinic Inc. reserves the right to amend and change responsibilities to meet business and organizational needs.

Hunter Health Clinic gives preference in employment opportunities to Native Americans who can perform required work regardless of age, sex, religion, or tribal affiliation.