REVENUE CYCLE DIRECTOR

GENERAL DESCRIPTION OF POSITION:

Under the direction of the Chief Finance Officer, this position oversees the entire revenue cycle process including credentialing, patient registration, insurance verifications, billing and collections and ensuring compliance with federal, state, and FQHC regulations. Develop strategies to minimize bad debt, enhance revenue capture, and improve the overall cash flow and financial viability of the organization. Collaborates with CMO and other clinical units to ensure accurate and timely documentation and coding of services rendered for billing purposes. Negotiates contracts with payers including Medicare, Medicaid, Commercial, other third-party insurers, Managed Care Organizations, Individual Provider Agreements, and Accountable Care Organizations, to secure favorable reimbursement rates and terms. Provides direct management of the Insurance Credentialing Department, Value Based Care Department, Billing Supervisor, and the Third-Party Billing and Collections Supervisor.  All interaction with the patients is in adherence with PCMH principles, policies, and procedures with a focus on customer relations.  

ESSENTIAL JOB FUNCTIONS: (why this job exists)

The Revenue Cycle Director provides strategic and operational leadership for all aspects of the organization’s revenue cycle, ensuring compliant, efficient, and patient-centered processes that support the financial health and sustainability of the Clinic.

• Directs the full revenue cycle process, from provider insurance credentialing, patient registration and insurance verification through billing, collections, and reimbursement, ensuring claims are timely and accurately submitted and that all HRSA, FQHC, and applicable regulatory requirements are met.
• Meets regularly with the Chief Financial Officer to ensure revenue cycle strategies are aligned with organizational financial goals and key performance indicators.
• Ensures compliance with federal, state, and payer regulations related to billing, collections, documentation, and coding; develops and delivers ongoing training to maintain compliance across all revenue cycle functions.
• Develops and implements strategies to minimize bad debt, maximize revenue capture, improve cash flow, and enhance the overall financial viability of the Clinic.
• Collaborates closely and meets regularly with the Chief Medical Officer and clinical leadership to ensure accurate, complete, and timely clinical documentation and coding to support compliant billing and optimal reimbursement.
• Leads Skilled Billing Lab training and related educational initiatives for providers, nursing, X-Ray, and laboratory staff to strengthen documentation quality, coding accuracy, and charge capture.
• Assists CFO with negotiating and managing payer contracts, including Medicare, Medicaid, commercial insurers, Managed Care Organizations, Individual Provider Agreements, and Accountable Care Organizations, to secure favorable reimbursement rates, contract terms, and operational requirements.

Leadership & Department Management

• Supervises, evaluates, coaches, and counsels supervisors with direct responsibility for the Insurance Credentialing Department, Value-Based Care (VBC) Department, Billing operations, and Third-Party Billing and Collections functions.
• Ensures supervisors and staff remain current on billing and collection policies, procedures, and evolving methodologies.
• Monitors regulatory and payer changes impacting billing and collections and ensures timely updates to policies, procedures, and staff training.
• Conducts regular staff and leadership meetings, resolves revenue cycle issues at the operational level, and escalates significant concerns to the Chief Financial Officer as appropriate.
• Identifies departmental training needs and ensures appropriate education and competency development for staff.

Credentialing, Performance Improvement & Audits

• Ensures all providers are credentialed and re-credentialed timely with all applicable payers to prevent participation gaps and reimbursement delays.
• Assists the Chief Financial Officer in building operational efficiencies and aligning revenue cycle performance with organizational expectations.
• Reviews, develops, and recommends new or improved procedures to enhance billing and collections performance and increase revenue.
• Updates revenue cycle policies and procedures and ensures consistent implementation across all clinic locations.
• Initiates data collection and analyzes trends to identify performance gaps and opportunities for improvement.
• Conducts internal audits, reports findings and recommendations to the Chief Financial Officer, and participates in external audits as required.

DIRECTLY SUPERVISED:  Billing and Collections Supervisors; Insurance Credentialing Department, Value Based Care Department

KNOWLEDGE, SKILLS, AND ABILITIES: (use of equipment, job related knowledge, language, etc.)

Willingness to stay abreast of and operate within Su Clinica policies and procedures.

Expert knowledge of private insurance, Medicare, and Medicaid claims filing.

Expert knowledge of CPT and ICD-10 coding requirements.

Experience working with value-based care contracts.

Adept in providing effective Customer Service daily.

Ability to effectively use computer programs in the course of daily work (Microsoft Word, Excel, Outlook, etc.)

Skilled in planning, organizing, delegating, and supervising personnel.

Skilled in gathering and interpreting data and presenting reports.

Ability to read, write and spell accurately.

Ability to maintain an effective and professional working relationship with the public, direct staff, and co-workers.

Able to record, prepare and communicate appropriate reports.

Ability to maintain a positive work environment.

Ability to work in a fast paced environment.

Ability to maintain a flexible work schedule.

Ability to maintain client and office confidentiality.

EXPERIENCE DESIRED/CERTIFICATION REQUIRED:

Bachelor’s degree in business administration. Master’s degree preferred Minimum of four years of experience working in a healthcare environment. Minimum of four years working with Commercial and Private Insurance, Medicare and Medicaid claims filing in an automated system. Minimum of five years of experience in supervising personnel. Minimum of three years working in a FQHC in billing and collections, preferred.

SPECIAL INSTRUCTIONS:

Due to the nature of Su Clinica Services, it may be necessary for employees to work extended hours or other variations of the usual shift to ensure adequate care for patients and to maintain service to the community.