Job Description

Job Description

Job Description

The Revenue Cycle Director provides strategic leadership and operational oversight of the revenue cycle for a Federally Qualified Health Center (FQHC) with multiple health center sites. This includes managing front-end revenue operations, overseeing a third-party billing vendor, in-house revenue teams, and ensuring regulatory compliance with all payer requirements. The position is responsible for leading the preparation of including but not limited to the annual Prospective Payment System (PPS) cost reports and managing Medicare and Medicaid reconciliations, which are essential to securing full and accurate reimbursement. Serve as a master user in the organization’s EHR platform.

Key Responsibilities:

• Direct all aspects of the revenue cycle operations, including overseeing entered patient registration, insurance verification, charge capture, and point-of-service payment collection to ensure accurate and timely claim submissions.
• Partner with the third-party billing vendors, while managing internal billing teams to ensure efficient claims processing and follow-up, accurate payment posting, and effective denial management resolution.
• Monitor and manage third-party billing vendor(s) performance through KPIs, SLAs, and routine performance reviews.
• Ensure compliance with FQHC billing regulations, including Medicaid PPS/APM, sliding fee scales, wraparound payments, and 340B program billing.
• Collaborate with finance, compliance, and operational leaders to establish and maintain accurate medical coding, documentation requirements, and charge entry procedures.
• Direct the annual preparation and submission of PPS cost reports in partnership with finance teams and external consultants, ensuring precision and timely delivery.
• Develop and maintain monthly reporting to streamline efficiency and support ongoing cost reporting efforts.
• Manage Medicare and Medicaid reconciliations, ensuring appropriate documentation and follow-up for adjustments, overpayments, and settlements.
• Prepare and present monthly revenue reports to the CFO and executive leadership, analyzing collections, encounter volume, payer mix, A/R trends, and reimbursement performance.
• Optimize use of EPIC via OCHIN, including reporting tools like Clarity, SlicerDicer, and Reporting Workbench, to drive data-informed decisions. Demonstrate expertise in readiness to adapt to new healthcare technology platforms as business needs evolve.
• Coordinate with clinical and administrative teams to ensure efficient workflows and revenue cycle performance across all service lines including but not limited to medical, dental, behavioral health, and enhance care management.
• Oversee internal audits, assist with payer audits, and support UDS and HRSA reporting requirements.
• Supervise and develop a high-performing revenue cycle support team, fostering collaboration and accountability.

Qualifications:

Education:

• Bachelor’s degree in Healthcare Administration, Business, Finance, or related field required.
• Master’s degree preferred.

Experience:

• 7–10 years of revenue cycle management experience, with at least 3–5 years in a leadership role.
• Prior experience in a large, multi-site FQHC is required.
• Hands-on experience with third-party billing vendor oversight.
• Deep understanding of PPS cost reporting, Medicare/Medicaid reconciliations, and wraparound payment processes.
• Proficiency with EPIC (OCHIN) and related analytics/reporting tools.

Skills:

• Strong knowledge of FQHC-specific reimbursement, cost reporting, and compliance regulations.
• Excellent analytical, organizational, and problem-solving skills.
• Ability to interpret complex financial and operational data to drive improvement.
• Strong leadership, team development, and vendor management capabilities.
• Excellent verbal and written communication skills, with the ability to present to executive stakeholders.

Gregg Carroll Recruiting Services, LLC is an independent executive search firm serving customers throughout the United States.

Company Description

Gregg Carroll Recruiting Services, LLC is an independent executive search firm serving customers throughout the United States.

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