Position Summary
The Director of Revenue Cycle Management provides strategic oversight and operational leadership for all revenue cycle functions within a Federally Qualified Health Center (FQHC) environment. This role is responsible for improving patient revenue optimization, billing operations, coding compliance, risk adjustment initiatives, claims management, payer relations, and reimbursement performance.
The director works closely with clinical, operational, finance, and third-party billing teams to ensure compliant, efficient, and financially sustainable revenue cycle operations that support access to high-quality patient care.
Key Responsibilities
- Direct and oversee all revenue cycle operations, including registration, charge capture, coding, billing, claims processing, payment posting, denial management, collections, and reimbursement analysis.
- Lead revenue cycle strategy and performance improvement initiatives to maximize cash flow, reduce denials, and improve financial outcomes.
- Monitor revenue cycle metrics such as A/R trends, denial rates, clean claim rates, payer mix, days in A/R, and collection performance.
- Ensure compliance with FQHC billing regulations, HRSA requirements, Medicare, Medicaid, commercial payer guidelines, and other regulatory standards.
- Oversee coding compliance and risk-adjustment capture efforts in collaboration with providers and coding staff.
- Manage relationships with third-party billing vendors, clearinghouses, and payer representatives.
- Develop and implement policies, procedures, workflows, and internal controls related to revenue cycle operations.
- Partner with leadership to improve documentation accuracy, charge integrity, and reimbursement outcomes.
- Coordinate payer credentialing oversight and support contracting initiatives as needed.
- Lead audits, payer reviews, repayment responses, and corrective action planning.
- Prepare and present revenue cycle reports, financial analyses, and operational updates to executive leadership.
- Identify opportunities for workflow optimization, automation, EHR improvements, and operational efficiencies.
- Support annual budgeting, forecasting, and financial planning related to patient revenue.
- Supervise, mentor, and evaluate revenue cycle staff.
Requirements & Qualifications
Qualifications
- Bachelor's degree in healthcare administration, business, finance, health information management, or a related field preferred; equivalent experience may be considered.
- Minimum of 5 years of progressive revenue cycle experience in healthcare.
- Minimum of 2 years of leadership or supervisory experience.
- Strong knowledge of CPT, HCPCS, ICD-10, FQHC billing regulations, PPS reimbursement methodologies, Medicare, Medicaid, and commercial payer requirements.
- Experience managing denials, payer audits, appeals, and reimbursement optimization initiatives.
- Knowledge of coding compliance and documentation improvement practices.
- Strong analytical, organizational, communication, and problem-solving skills.
- Experience working with EHR and practice management systems.
- Ability to collaborate effectively with clinical, operational, and financial leadership teams.
Preferred Qualifications
- Experience in a Federally Qualified Health Center (FQHC) strongly preferred.
- CPC, CRCR, CCS, or a related certification preferred.
- Experience overseeing outsourced billing vendors.
- Familiarity with NextGen, EPIC, or similar healthcare systems.
- Experience with value-based care, quality incentive programs, and risk-adjustment methodologies.
Benefits & Perks
Benefits
- Health insurance and rewards program
- Dental insurance
- Vision insurance
- Free life insurance
- Free short-term disability insurance
- 403(b) retirement plan with employer match
- Comprehensive paid time off (PTO)
- 10 paid holidays
Location
Cincinnati, Ohio, US
Employment Type
Full-time
Experience Level
Director
Remote work allowed
Yes
Posted
1 month ago
Browse More Jobs