Revenue Cycle Manager

Description

Purpose of Position: The Revenue Cycle Manager is responsible for the oversight and management of all functions within the revenue cycle for Valley Family Health Care (VFHC), a Federally Qualified Health Center (FQHC) operating in Western Idaho and Eastern Oregon. This role encompasses patient access, billing, payment posting, collections, electronic health records (EHR) as it relates to revenue cycle, and customer service. The Revenue Cycle Manager ensures the optimization of revenue generation, maintenance of a healthy financial cycle, and adherence to all relevant regulations and payer requirements in Oregon and Idaho. This leader will develop and implement strategies to improve efficiency, accuracy, and compliance across the revenue cycle, working collaboratively with other departments to achieve VFHC’s financial goals and mission.

RESPONSIBILITIES:

1. Departmental Oversight and Management: Provide leadership and oversight to all revenue cycle departments, including registration, scheduling, Sliding Fee Program, coding, credentialing, billing, payment posting, collections, credentialing, and EHR functions as they relate to revenue cycle. Collaborate and act as primary liaison between third-party billing and coding teams and VFHC clinic teams.
2. Team Leadership and Development: Recruit, hire, train, mentor, and evaluate revenue cycle customer service staff. Build and lead high-performing teams, providing clear expectations, ongoing feedback, and opportunities for professional development.
3. Onboarding & Ongoing Training Oversight: Work with Front Office Coordinator, Practice Managers and Patient Service Representative Leads to onboard and train employees on patient registration, scheduling appointment management, sliding fee discount, patient collections, customer service, insurance verification, benefits eligibility, and optimizing workflow efficiencies to enhance staff satisfaction and patient experience.
4. Revenue Cycle Optimization: Continuously evaluate and optimize all revenue cycle processes to improve efficiency, accuracy, and cash flow. Identify and implement best practices and innovative solutions. Assist with evaluation of new payment models and contracts.
5. Billing, Coding and Accounts Receivable Management: Together with third party billing and coding team, ensure that all billing and coding practices comply with regulations and guidelines. Work with payers and third party billing team to identify root causes of denials and implement correction actions. Oversee the overall management of accounts receivable. Develop metrics to evaluate third party billing and coding contractor and hold them accountable to high standards of accuracy, customer service, and reliability.
6. Patient Access and Financial Services: Together with the service line directors, ensure efficient and patient-centered patient access processes, including registration, insurance verification, and financial counseling. Oversee the Sliding Fee Discount and payment plan programs.
7. Payer Relations and Contracting: Develop and maintain strong relationships with payers, including Medicare, Medicaid (in Oregon and Idaho), and commercial insurance companies. Participate in payer negotiations and ensure contract compliance.
8. Technology and Systems Optimization: Provide guidance on the effective utilization of the OCHIN Epic EHR and other relevant technologies. Collaborate with the VFHC Data and Applications teams and OCHIN teams to optimize system functionality and reporting capabilities.
9. Performance Monitoring and Reporting: Establish and monitor key performance indicators (KPIs) across all revenue cycle functions. Analyze data, identify trends, and provide regular reports to senior leadership on revenue cycle performance.
10. Cross-Departmental Collaboration: Foster strong working relationships and effective communication with other departments within VFHC, including clinical operations, finance, applications and data, to ensure seamless workflows and alignment of goals. Provide training materials and feedback to clinical teams.
11. Compliance and Risk Management: Ensure compliance with all relevant federal and state regulations, HIPAA privacy and security standards, and organizational policies related to the revenue cycle. Identify and mitigate potential risks. Participate in internal and external audits related to the revenue cycle and implement recommendations for improvement.
12. Fee Schedule Maintenance: Review and recommend changes to the CFO and board annually and provide recommendations for approval of fee increases, including costs of supplies.  
13. Other duties as assigned.

Requirements

QUALIFICATIONS: 

1. Bachelor’s degree in healthcare administration, business administration, finance, or a related field required. 
2. Minimum of 5 years of progressive leadership experience in healthcare revenue cycle management, including experience in registration, scheduling, billing, coding, payment posting, accounts receivable management. Experience in an FQHC setting is highly preferred. 
3. Demonstrated ability to develop and implement revenue cycle initiatives and achieve measurable results.
4. Demonstrated ability to develop training and accountability systems for patient access (front desk) teams.
5. Exceptional communication, interpersonal, and presentation skills, with the ability to effectively communicate with all levels of staff, leadership, external partners, and payers.
6. Advanced competency in utilizing and optimizing electronic health record (EHR) systems and other relevant healthcare technology. Prior experience with OCHIN Epic is preferred.
7. Comprehensive and in-depth knowledge of CPT and ICD-10 coding principles, healthcare billing regulations (federal, state, and payer-specific in Oregon and Idaho), HIPAA compliance, and payer requirements.
8. Strong ethics and a high level of personal and professional integrity.

Physical Requirements:   

1. Must be able to lift 25 lbs.
2. Continuous sitting, standing, walking.
3. Correctable vision and hearing.
4. The ability to communicate information and ideas so others will understand. Must be able to exchange accurate information in these situations.
5. The ideal candidate must be able to complete all physical requirements of the job with or without a reasonable accommodation.