Director of Revenue Cycle

Financial Performance and Analytics

• Develop and maintain reporting and dashboards to monitor key revenue cycle metrics including AR days, denial rates, clean claim rates, collections performance, and payer-specific trends.
• Prepare and present revenue cycle performance reviews to executive leadership.

Coding Compliance and Education

• Develop and deliver clinical billing and training content for providers and clinical front-end users; coordinate with Medical Services leadership to ensure consistent coding and documentation practices across the organization.
• Act as the primary liaison between the billing department and internal departments ensuring clear communication, updates to billing processes and procedures, identification of trends, issue resolution, and continuous workflow improvement
• Collaborate with Health Center Managers and Medical Services leadership to optimize front-end revenue cycle processes including patient registration, insurance verification, eligibility checking, sliding fee scale application, and point-of-service collections

Auditing Compliance and Grants Support

• Ensure all billing activities comply with federal and state regulations, HIPAA privacy and security requirements, payer contract terms, and Planned Parenthood’s organizational standards and mission
• Collaboratively review the coding audits with operations and IT analysts to identify training and system enhancements to improve compliant billing and coding.
• Support billing and documentation requirements for the Title X Family Planning Program, including sliding fee scale compliance, service coding, and federal reporting obligations

Payer Relations and Contract Management Support

• Direct third-party payer contract negotiations, management, and payer relations, including MCO contracts, fee schedule reviews, and dispute resolution.
• Ensure complete, accurate, and timely data is maintained in Epic and that internal operations supports clean claim submission; identify and resolve data or workflow gaps that impact billing performance

Strategy and Special projects

• Actively participate in strategic discussions and planning activities in collaboration with the Chief Financial Officer and Chief Executive Officer.
• Manage Revenue Cycle Work Plan and actively execute various projects and initiatives identified in prior Revenue Cycle assessments, approved work plan and identified priorities.
• Manage the risk assessment and quality management process and activities of the Revenue Cycle, including the following:
• • Revenue optimization initiatives and needs for PPWP team
  • Evaluation of risk areas, including mitigation of identified risks

• Actively participate in any financial and other compliance audits, specifically related to Revenue Cycle. 
• Liaise with other PA affiliates to strategize state-wide revenue enhancement

Staff Leadership and Development

• Recruit, onboard, develop, and retain a small revenue cycle team; set clear performance expectations and conduct regular performance evaluations
• Foster a culture of accountability, continuous improvement, and mission alignment within the revenue cycle function
• Perform other duties as assigned by the Chief Financial Officer

Epic & Technology

• Expert-level working knowledge of Epic Resolute Professional Billing, including claim submission, work queue management, ERA/EOB processing, RTE, and reporting tools
• Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data modeling)
• Familiarity with clearinghouse platforms (e.g., Availity, Change Healthcare/Optum) and electronic claim submission processes

Coding & Compliance

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• Thorough knowledge of CPT, ICD-10-CM/PCS, and HCPCS Level II coding, with specific familiarity with reproductive health service coding including contraceptive management, family planning, and abortion services
• Strong understanding of federal and state Medicaid programs, Medicaid MCO billing requirements, and managed care contract structures
• Knowledge of Title X program billing requirements, sliding fee scale regulations, and federal family planning service documentation standards
• Familiarity with HIPAA privacy and security regulations and their application to billing, data sharing, and vendor management
• Understanding of value-based payment models and quality-based incentive structures as they affect revenue cycle operations

Leadership & Communication

• Proven ability to lead, develop, and motivate a diverse team in a multi-site, mission-driven healthcare environment
• Excellent analytical, strategic, and problem-solving skills; ability to translate complex data into clear, actionable insights for executive and clinical audiences
• Strong oral and written communication skills; able to present ideas convincingly and concisely to both technical and non-technical stakeholders
• Strong commitment to reproductive health equity, patient-centered care, and Planned Parenthood’s mission and values
• Well organized with demonstrated ability to manage competing priorities, set timelines, and drive results
• Ability and willingness to travel to affiliate health center locations as needed