Revenue Cycle Director

Revenue Cycle Director

The Revenue Cycle Director is responsible for overseeing the entire revenue cycle process, including patient registration, coding, billing, claims submission, payment posting, denial management, collections, and reporting, with the primary goal of maximizing revenue and ensuring compliance with regulations by strategically managing processes and leading teams across the revenue cycle functions. The Revenue Cycle Director will work closely with various departments to streamline processes, improve financial performance, and ensure compliance with regulations.

ESSENTIAL FUNCTIONS

• Directs and oversees revenue cycle management (RCM) functions by providing leadership, organizational, and strategic direction to drive efficient, accurate, and compliant RCM billing activities to maximize reimbursement for health center operations, as well as the retail Pharmacy.

• Works closely with clinical, operations, administrative, pharmacy and financial departments to ensure a seamless revenue cycle process.
• Plans, develops, and implements programs, projects, strategies, processes, and technologies (including AI) to continuously improve and manage the revenue cycle for efficiency and maximized collections.
• Develops and ensures implementation of policies, guidelines, and implementation procedures; and ensures goals and objectives are properly defined and clearly established.
• Execute strategies to decrease the uninsured rate, including implementing action plans to prevent patients from being dropped during insurance redetermination processes.
• Creates system to hold denials to benchmark levels.
• Lead the strategy and execution of payer contract management both medical and dental services, maximizing incentives and improve revenue collection. Collaborate with Quality and Operations on payer contracts.
• Addresses missed billing opportunities by implementing billing practices to collect on revenues for services provided and not reimbursed for. For example, Medicare 519 billing, missed charge codes, and nurse co-visits.
• Proactively identify and address missed revenue opportunities throughout the organization. Develop strategies to explore additional revenue-producing activities such as CCM, ECM, and additional revenue producing pharmacy services.
• Conduct regular inventory of pharmacy payer contracts and lead efforts to renegotiate contracts as necessary.
• Ensure billing contracts and setups for new health center locations are completed, coordinating closely with the Compliance department to ensure all requirements are met.
• Drive initiatives to decrease denial rates and improved collections by ensuring operations and clinic health center staff are properly educated on best practices.
• Oversee clinician documentation, coding, and other aspects of revenue cycle management that impact reimbursement.
• Frequently report out to peers and Csuite leadership on determined KPIs, such as denials, revenue collected per visit, pharmacy revenue per script, uninsured rate, Accounts Receivable/aging days, and other key metrics.

Additional Duties

• Collaborate with clinical teams to provide ongoing education and training to ensure proper documentation and coding practices are followed.
• Consultation with, and shared authority over, the workflows of the following departments:
  • Call Center
  • Front Office
  • Clinician Documentation and Billing
  • EPIC teams
  • Pharmacy
• And other duties as assigned

TRAVEL RESPONSIBILITIES

• Minimal travel required between clinic sites.

SUPERVISORY RESPONSIBILITIES

• Direct supervision of the Billing and Eligibility Departments.

MINIMUM REQUIREMENTS

• 7-10 years of experience in functions related to revenue cycle management, with at least 5 years in a leadership role.
• Strong analytical, communication, and leadership skills, with the ability to collaborate effectively across departments.
• Experience in billing and claims submission, denial management, and payment posting.
• Solid understanding of payer contract, including ability to negotiate
• Expertise in the following areas, typically gained from 5+ years in a leadership role
  • Strong leadership, communication, and interpersonal skills,
  • Developing department objectives and measurements to meet organizational goals.
  • Staff selection and development
  • Management of department workload

PREFERRED BACKGROUND

• Bachelor's degree in Healthcare Administration, Business, Accounting, Finance or related field.
• Understanding of FQHC contract management and billing
• Certified Revenue Cycle Representative (CRCR), Certified Healthcare Financial Professional (CHFP), or any Medical Coding certificate
• One Community Health serves a widely diverse patient population with a rich blend of races, ethnicities, cultures, ages, religions, disabilities, sexual orientations, gender identities, and socioeconomic backgrounds. Individuals with life experience in these areas contribute to our ability to serve this population more effectively.
• Demonstrated person-centered approach and familiarity with trauma informed systems and restorative practices

Reasonable Accommodations

One Community Health endorses and supports the Americans with Disabilities Act of 1990 (ADA) and the California Fair Employment and Housing Act (FEHA) and is committed to providing reasonable accommodations to qualified individuals with disabilities who are applicants or employees who need accommodations. If you require and accommodation due to a disability to complete this application or you are experiencing difficulty submitting your application, please contact us at .

Our Benefits

For more information on the comprehensive benefits we provide, please visit:

Additional Information:

We only employ US citizens and non-US citizens authorized to work in the United States in compliance with federal law.