ESSENTIAL FUNCTIONS: The RCM will perform the following duties personally or through subordinates.

• Oversee and optimize centralized billing operations, supervising all related roles for Medical and Dental Billing that’s comprised of Central Office Billing.
• Formulate, assess, and update billing and reimbursement policies and procedures based on changes in laws, policies, and under the advisement of supervisory and executive staff.
• Maintain confidentiality and adherence to standard accounting practices in accounts receivable.
• Uphold stringent internal control measures over accounts receivables.
• Secure cash payment processes and assure all processes are followed.
• Track and manage collections, insurance claims, and third-party payments.
• Analyze and ensure compliance with third-party reimbursement policies; investigate and escalate discrepancies.
• Stay current with CMS policies and third-party contracts, private insurers, and government regulations.
• Solves operational issues and customer service issues in coordination with supervisor.
• Ensure that all critical issues are escalated to the Director of Finance and executive team.
• Support training and communication initiatives for Front Desk operations, Practice and Operations Management, and provider staff.
• Collaborate with external stakeholders for financial studies and audits concerning patient accounts.
• Manage charge postings, denials, billing, and collections for outpatient services, enforcing consistent policy application and reimbursement consistent with services rendered.
• Develop and conduct staff training and development programs to include evidence of gaining new knowledge.
• Organize staff schedules to guarantee optimization of the revenue cycle based on size, scale, and scope of the medical and dental practices.
• Host departmental meetings to communicate procedural changes as often as necessary.

• Collaborate with the financial and executive leadership on issues that impact the organizational budget and organization’s strategic plans.
• Conduct research and procurement for necessary business tools or business intelligence that support and enhance the department.
• Serves as liaison between the department and other departments as needed to insure the best billing practices and compliance across the organization.
• Meet with the clinical and credentialing department regularly to insure they are aware of any issues related to denials or coding.
• Ensure that activities of the department align with the organization’s budget and strategic plans.
• Compile and present detailed reports and analyses on billing, collections, and reimbursements.
• Participate in HRSA, Joint Commission, and other accrediting bodies on all audits that occur in the organization.
• Implement metrics and KPIs (Key Performance Indicators) to monitor and report on the efficiency and effectiveness of billing operations.
• Develop strategies for reducing the time from service delivery to payment receipt.
• Engage with IT department to leverage technology in improving billing processes, ensuring system optimization and data integrity with coordination of supervisor.
• Foster a culture of continuous improvement, encouraging innovation and efficiency in billing processes.
• Evaluate customer satisfaction regarding billing issues and develop strategies to enhance the patient financial experience.
• Negotiate and manage contracts with insurance payers, including Medicaid, Medicare, and private insurers, to ensure favorable reimbursement rates and terms for the FQHC.
• Develop strategies for reducing denials and improving the appeals process. Analyze denial patterns to identify root causes and implement corrective actions to prevent future denials.
• Perform regular financial analyses to track the health center's performance. Use data to identify trends, opportunities for improvement, and areas of concern in the revenue cycle.
• Work closely with clinical staff and the billing team members to ensure accurate documentation and coding for services rendered, facilitating appropriate billing and maximizing revenue.

• Ensure compliance with HIPAA and other relevant regulations concerning patient financial information.
• Prepare and present billing department status reports to the Director of Finance and CFO monthly.
• Mentor and develop billing department staff and foster a team-oriented environment.
• Communicate with key stakeholders, third party managed care contracts to align services with reimbursements.
• Communicate, report, track, and monitor transactions with electronic medical record vendors for reporting or recording for timely billing.
• Oversight of billing, coding, and documentation geared towards first pass clean claims as contracted.
• Fulfill additional responsibilities as designated by the CFO or CEO.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty optimally. The requirements listed below are representative of the knowledge, skills, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION/EXPERIENCE:

Bachelor’s degree from a four-year college or university in Finance, Business Administration, Health Information Management, or a related field; or an equivalent combination of education and experience in a relevant area.

A minimum of three (3) years of direct experience in billing and coding, with a strong emphasis on practical application and hands-on training in this field. Current certification as a Certified Biller and Coder, with a commitment to maintaining this certification and staying abreast of industry changes.

KEY COMPETENCIES:

CRITICAL THINKING AND PROBLEM SOLVING: Ability to analyze complex billing scenarios, identify discrepancies, and develop effective solutions. The candidate should demonstrate a track record of resolving billing issues efficiently and creatively.

COLLABORATION AND COMMUNICATION SKILLS: Strong ability to work cohesively with a team, including cross-departmental collaboration. Excellent verbal and written communication skills are essential for effectively conveying billing information and resolving issues with clients and team members.

ANALYTICAL SKILLS: Proficiency in analyzing billing data, interpreting trends, and making data-driven decisions. The candidate should be adept at using analytics to improve billing processes and outcomes.

Use of technology and software to assist with analysis.

BUSINESS INTELLIGENCE: Strong skills in business intelligence tools and technologies relevant to billing and coding. The candidate should be able to leverage BI tools to enhance billing accuracy, efficiency, and compliance.