Director of Revenue Cycle

Mission: The Director of Revenue Cycle Management is responsible for the strategic and operational oversight of the full revenue cycle for a Federally Qualified Health Center (FQHC) with a high volume of value-based reimbursement arrangements. This role ensures accurate charging, timely billing, optimized cash collections, effective denial management, and strong revenue integrity controls across all service lines.

The Director serves as a key financial leader, partnering closely with Finance, Clinical Operations, Contracting, and Quality teams to align revenue cycle performance with value-based care objectives, regulatory requirements, and organizational financial goals, while directly reporting to the Chief Financial Officer (CFO).

Supervising Billing Manager; manages the Business Office and revenue cycle teams

Lead front-end operations (registration, eligibility) and back-end operations (coding, billing, collections, denials) to maximize reimbursement, ensuring strict compliance with Medicaid, Medicare, PPS, and grant rules while providing strategic leadership, managing staff, improving process, and optimizing patient financial interactions.

Location: Honesdale, PA (In-Office) 

Duties/Responsibilities:

Revenue Cycle Leadership & Strategy

• Provide strategic leadership for all revenue cycle functions, including charge capture, billing, accounts receivable, cash posting, denial management, and revenue integrity.
• Develop and execute revenue cycle strategies that support value-based contracts, alternative payment models, and FQHC-specific reimbursement methodologies.
• Serve as the primary revenue cycle liaison to the CFO, providing regular reporting on performance, risks, trends, and improvement opportunities.

Value-Based Care & Contract Performance

• Partner with Finance and Contracting teams to ensure accurate revenue recognition and performance tracking for value-based, capitated, and incentive-based contracts.
• Collaborate with Quality and Clinical Leadership to align revenue cycle processes with quality metrics, risk adjustment, and performance measures.
• Monitor payer performance and reimbursement trends to identify opportunities for optimization and financial sustainability.

Charging, Billing & Accounts Receivable

• Oversee charge capture processes to ensure completeness, accuracy, and compliance with FQHC billing rules and payer requirements.
• Ensure timely and accurate claims submission across all payers, including Medicaid, Medicare, managed care, and commercial payers.
• Manage accounts receivable performance, including aging, follow-up workflows, and resolution of complex balances.

Denial Management & Cash Collections

• Establish and oversee a comprehensive denial management program focused on prevention, root-cause analysis, and recovery.
• Monitor cash collections, payment posting accuracy, and reconciliation processes to maximize net revenue and cash flow.
• Implement performance benchmarks and accountability measures to drive continuous improvement in cash performance.

Revenue Integrity & Compliance

• Lead revenue integrity initiatives to ensure compliant charging, coding alignment, and documentation support.
• Collaborate with Compliance and Audit teams to address regulatory requirements, audit findings, and payer inquiries.
• Ensure adherence to FQHC, CMS, state Medicaid, and payer-specific billing regulations.

Team Leadership & Development

• Directly manage the Business Office and revenue cycle teams, providing coaching, performance management, and professional development.
• Foster a culture of accountability, collaboration, and continuous improvement within the revenue cycle function.
• Evaluate staffing models, workflows, and technology to ensure scalability and efficiency

Payer Relations

• Oversee payer contracts and relationships, including enrollment for new providers.

Process Improvement:

• Analyze current procedures, identify inefficiencies, and implement changes to optimize workflow and collections.

Technology & Systems:

• Utilize and manage billing software, EMR/EHR systems, and RCM tools.

Competencies:

Operational Excellence: Consistently improves processes, quality, and efficiency to meet organizational goals.

People Management: Recruits, develops, and holds staff accountable for performance and professional growth

Problem-Solving & Strategy: Ability to troubleshoot complex billing issues, identify revenue leakage, and develop strategic solutions for optimization.

Collaboration: Works effectively across departments to achieve shared objectives

Accountability: Takes ownership of results and follows through on commitments

Financial & Analytical Skills: Ability to analyze RCM metrics, interpret financial reports, manage budgets, understand payer contracts, and drive process improvements.

Leadership & Communication: Proven ability to lead teams, foster collaboration, communicate complex data to diverse stakeholders (staff, providers, leadership), and manage change.

Payer Knowledge: Comprehensive understanding of various payers (Medicare, Medicaid, Managed Care, Tricare, Workers Comp) and their unique rules.

Required Minimum Qualifications:

• Bachelor’s degree in Healthcare Administration, Finance, Business, or a related field.
• Minimum of 7 years of progressive experience in healthcare revenue cycle management.
• Demonstrated experience supporting FQHC operations and reimbursement, including Medicaid and Medicare.
• Strong understanding of value-based payment models, alternative payment arrangements, and revenue recognition.
• Proven leadership experience managing business office and revenue cycle teams.

Added-Value Qualifications and Experience:

• Certified Revenue Cycle Professional (CRCP
• Strategic and analytical thinking
• Strong financial and operational acumen
• Collaborative leadership and communication
• Regulatory and compliance awareness
• Change management and process improvement

Required Skills/Abilities:

• Knowledge of all applicable Federal, State and Local laws
• Keep current with trends and developments related to essential job competencies
• Commitment to and demonstration of excellent internal and external customer service
• Attention to detail, ability to lead and follow processes and procedures from beginning to end
• Able to demonstrate interpersonal and relationship-building and project management skills
• Strong organizational skills; ability to balance priorities and contribute as a team player within the organization
• Ability to utilize data and promptly inform others in decision-making process
• Entrepreneurial spirit, intellectual curiosity, high energy, positive attitude and diplomatic
• Has computer skills and ability to learn/operate software programs
• Maintains professional appearance and demonstrates professional attitude at all times