Revenue Cycle Manager

Position Summary

The Revenue Cycle Manager is responsible for overseeing and optimizing all aspects of the revenue cycle for Health Care Partners of South Carolina. This position provides leadership for patient registration, insurance verification, coding, billing, payment posting, accounts receivable, and collections while ensuring compliance with federal, state, payer, and Federally Qualified Health Center (FQHC) regulations. The Revenue Cycle Manager collaborates with clinical, administrative, and finance teams to maximize reimbursement, improve operational efficiency, and support a positive patient financial experience.

Essential Duties and Responsibilities

• Lead and oversee all revenue cycle operations, including patient registration, insurance verification, coding, billing, payment posting, accounts receivable, and collections.
• Supervise, mentor, and develop revenue cycle staff through training, coaching, and performance management.
• Monitor key performance indicators (KPIs), including accounts receivable, denial rates, clean claim rates, and collection performance, and implement strategies for continuous improvement.
• Ensure compliance with FQHC billing requirements, Medicare, Medicaid, commercial payer guidelines, and applicable federal and state regulations.
• Collaborate with providers, clinical staff, and administrative departments to promote accurate documentation, coding, and reimbursement.
• Review and resolve complex billing issues, claim denials, payer disputes, and reimbursement discrepancies.
• Oversee coding accuracy and compliance with CPT, HCPCS, and ICD-10 coding guidelines.
• Prepare revenue cycle reports and performance metrics for the Chief Financial Officer and executive leadership.
• Identify opportunities to improve workflows, increase operational efficiency, reduce denials, and enhance the patient financial experience.
• Maintain current knowledge of healthcare reimbursement regulations, payer policies, and revenue cycle best practices.
• Participate in organizational quality improvement initiatives, staff meetings, and leadership activities.
• Perform other duties as assigned.

Education & Experience

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or a related field required; equivalent experience may be considered.
• Minimum of five (5) years of progressive experience in healthcare revenue cycle management required.
• Experience working in a Federally Qualified Health Center (FQHC) or community health center strongly preferred.
• American Academy of Professional Coders (AAPC) certification or equivalent professional coding certification preferred.
• Experience managing billing, coding, accounts receivable, insurance claims, and reimbursement processes required.

Knowledge, Skills, and Abilities

• Comprehensive knowledge of healthcare revenue cycle operations, medical billing, coding, reimbursement methodologies, and payer regulations.
• Knowledge of CPT, HCPCS, ICD-10 coding, Medicare, Medicaid, commercial insurance, and FQHC billing requirements.
• Strong leadership, analytical, organizational, and problem-solving skills.
• Excellent communication and interpersonal skills with the ability to collaborate effectively across departments.
• Proficiency in Electronic Health Record (EHR), practice management, billing software, Microsoft Office, and reporting tools.
• Ability to analyze financial and operational data, identify trends, and implement effective process improvements.

• Knowledge of HIPAA regulations and the ability to maintain the confidentiality, security, and integrity of patient information.