What are the responsibilities and job description for the VP of Revenue Cycle position at Caring Health Center, Inc.?
VP of Revenue Cycle Job Category: Finance Requisition Number:
VPOFR001163 Full-Time Hybrid Springfield, MA 01103, USA Job Details
General Description: The Vice President (VP) of Revenue Cycle is
responsible for the strategic oversight and operational performance of
revenue cycle functions. This role plays a key part in ensuring
financial sustainability by maximizing reimbursements, improving cash
flow across all clinical and pharmacy service lines, strengthening payer
relationships, and ensuring full compliance with FQHC-specific billing
regulations. This role is also responsible for effective payer contract
negotiation, and the development and oversight of AR and financial
performance through reporting, data analysis, and key metrics. Reporting
to the Chief Financial Officer (CFO), the VP collaborates closely with
finance, clinical, operations, billing, compliance, pharmacy, and
credentialing teams to drive operational excellence and mitigate risk
across all service lines, including medical, dental, behavioral health,
and pharmacy (retail and 340B). While this position does not have direct
supervisory oversight of the Billing team, it holds a dotted-line
relationship and works in close partnership to ensure billing functions
are fully aligned with financial performance objectives, payer
Requirements, And FQHC Best Practices. Minimum Requirements
Associate\'s degree required; Equivalent experience considered.
Certified coder (CPC, CCS, or equivalent) strongly preferred. Minimum of
10 years in revenue cycle leadership, with FQHC or community health
center. Deep knowledge of FQHC billing regulations and payer
requirements (MassHealth, HSN, Medicare, Medicaid/Medicare ACO\'s, PPS,
wrap payments, capitation, etc.). Proven experience with pharmacy
billing, 340B revenue management, and retail pharmacy revenue cycle
workflows. Expertise in medical, dental, and behavioral health revenue
cycle management. Extensive knowledge of revenue cycle management,
including billing, coding, collections, reporting and analysis.
Expertise with state systems (e.g., MMIS) and electronic health record
platforms (e.g., eClinicalWorks, NextGen, Athena, Epic). Proven ability
and success in managing and negotiating payer relations and contracting.
Strong analytic skills with advanced Excel capability and data reporting
tools. Demonstrated ability to influence cross-functional teams without
direct authority. Excellent communication, leadership, and
problem-solving skills. High attention to detail, integrity, and
commitment to the organization\'s mission. Key Competencies: FQHC
Reimbursement Strategy & Compliance Revenue Cycle Analytics, Reporting &
Performance Metrics MassHealth, HSN, Medicare, Medicaid, and Commercial
Payer Expertise Pharmacy Revenue Cycle (Retail & 340B) Oversight
Contracting, Capitation, and Wrap Payment Management Cross-Functional
Collaboration & Process Improvement Credentialing Coordination & Denial
Mitigation Principal Responsibilities and Duties: Payer Contracting &
Reimbursement Strategy Review and support negotiation of third-party
payer contracts, including commercial payers, Medicare Advantage, and
Medicaid Managed Care plans. Analyze reimbursement terms, payment
methodologies, and ensure alignment with FQHC reimbursement models (PPS,
wrap payments, APMs). Track and report on payer performance trends;
identify opportunities for enhanced reimbursement. Serve as a subject
matter expert on FQHC-specific reimbursement rules, including
MassHealth, HSN, Medicare PPS, Medicaid ACOs, and state-specific billing
regulations. Review and validate quarterly MassHealth wrap payments and
monthly capitation payments; report discrepancies and trends to CFO.
Monitor payer policy changes and FQHC reimbursement guidance to ensure
organizational readiness. SEE THE CARING HEALTH CENTER WEBSITE FOR MORE
INFORMATION
VPOFR001163 Full-Time Hybrid Springfield, MA 01103, USA Job Details
General Description: The Vice President (VP) of Revenue Cycle is
responsible for the strategic oversight and operational performance of
revenue cycle functions. This role plays a key part in ensuring
financial sustainability by maximizing reimbursements, improving cash
flow across all clinical and pharmacy service lines, strengthening payer
relationships, and ensuring full compliance with FQHC-specific billing
regulations. This role is also responsible for effective payer contract
negotiation, and the development and oversight of AR and financial
performance through reporting, data analysis, and key metrics. Reporting
to the Chief Financial Officer (CFO), the VP collaborates closely with
finance, clinical, operations, billing, compliance, pharmacy, and
credentialing teams to drive operational excellence and mitigate risk
across all service lines, including medical, dental, behavioral health,
and pharmacy (retail and 340B). While this position does not have direct
supervisory oversight of the Billing team, it holds a dotted-line
relationship and works in close partnership to ensure billing functions
are fully aligned with financial performance objectives, payer
Requirements, And FQHC Best Practices. Minimum Requirements
Associate\'s degree required; Equivalent experience considered.
Certified coder (CPC, CCS, or equivalent) strongly preferred. Minimum of
10 years in revenue cycle leadership, with FQHC or community health
center. Deep knowledge of FQHC billing regulations and payer
requirements (MassHealth, HSN, Medicare, Medicaid/Medicare ACO\'s, PPS,
wrap payments, capitation, etc.). Proven experience with pharmacy
billing, 340B revenue management, and retail pharmacy revenue cycle
workflows. Expertise in medical, dental, and behavioral health revenue
cycle management. Extensive knowledge of revenue cycle management,
including billing, coding, collections, reporting and analysis.
Expertise with state systems (e.g., MMIS) and electronic health record
platforms (e.g., eClinicalWorks, NextGen, Athena, Epic). Proven ability
and success in managing and negotiating payer relations and contracting.
Strong analytic skills with advanced Excel capability and data reporting
tools. Demonstrated ability to influence cross-functional teams without
direct authority. Excellent communication, leadership, and
problem-solving skills. High attention to detail, integrity, and
commitment to the organization\'s mission. Key Competencies: FQHC
Reimbursement Strategy & Compliance Revenue Cycle Analytics, Reporting &
Performance Metrics MassHealth, HSN, Medicare, Medicaid, and Commercial
Payer Expertise Pharmacy Revenue Cycle (Retail & 340B) Oversight
Contracting, Capitation, and Wrap Payment Management Cross-Functional
Collaboration & Process Improvement Credentialing Coordination & Denial
Mitigation Principal Responsibilities and Duties: Payer Contracting &
Reimbursement Strategy Review and support negotiation of third-party
payer contracts, including commercial payers, Medicare Advantage, and
Medicaid Managed Care plans. Analyze reimbursement terms, payment
methodologies, and ensure alignment with FQHC reimbursement models (PPS,
wrap payments, APMs). Track and report on payer performance trends;
identify opportunities for enhanced reimbursement. Serve as a subject
matter expert on FQHC-specific reimbursement rules, including
MassHealth, HSN, Medicare PPS, Medicaid ACOs, and state-specific billing
regulations. Review and validate quarterly MassHealth wrap payments and
monthly capitation payments; report discrepancies and trends to CFO.
Monitor payer policy changes and FQHC reimbursement guidance to ensure
organizational readiness. SEE THE CARING HEALTH CENTER WEBSITE FOR MORE
INFORMATION