Director of Revenue Cycle

Job description

Empowering communities through accessible, inclusive, and compassionate care, this is the work we do every day. At Jane Pauley Community Health Center, every role is connected to something bigger. As a Federally Qualified Health Center (FQHC), we deliver integrated, whole-person care to individuals and families across Indiana, regardless of income or insurance status. Our teams work at the intersection of clinical excellence and community impact, supporting underserved populations while building a culture rooted in collaboration, respect, and growth. Here, you are not just joining a workplace, you are becoming part of a mission that truly matters. The Director of Revenue Cycle provides strategic, operational, and financial leadership for all revenue cycle management (RCM) functions across a large, multi-site FQHC. This position oversees end-to-end revenue cycle operations for an organization serving approximately 200,000 patient visits annually with a clinical network of approximately 300 clinicians. The Director is responsible for optimizing financial performance, cash flow, and regulatory compliance across a complex, multi-service clinical model that includes **Family Practice, Dental, Optometry, Behavioral Health Therapy, ASAM (Addiction/SUD Services), and OB/GYN services**. This role requires a highly analytical, mission-driven leader with extensive experience navigating FQHC regulations (PPS billing, HRSA compliance, sliding fee programs) and high-volume billing across both medical and behavioral health specialties. **Key Responsibilities** **Strategic Leadership & Financial Performance** - Develop, implement, and continuously improve a unified, organization-wide revenue cycle strategy aligned with financial sustainability and HRSA compliance objectives. - Serve as the principal advisor to the executive leadership team on RCM performance, regulatory updates, and emerging reimbursement models. - Monitor and manage key performance indicators (KPIs) including Days in A/R, Clean Claim Rate, Denial Rate, Net Collection Rate, and Cost to Collect. - Lead annual revenue cycle budgeting, forecasting, and goal-setting processes for all service lines. - Collaborate cross-functionally with Clinical, Operations, IT, Compliance, and Finance leadership to align clinical documentation with optimal charge capture. **Revenue Cycle Operations & Service Line Management** - Oversee all daily front-end and back-end revenue cycle operations, including patient registration, insurance verification, sliding fee scale (SFS) assessment, copay collection, coding, billing, claims submission, payment posting, and collections. - Standardize and manage billing, coding, and workflow requirements across a highly diverse set of clinical specialties: - **Family Practice:** FQHC Prospective Payment System (PPS) reimbursement, sliding fee discounts, preventive care, and preventive-to-chronic care transition billing. - **Behavioral Health (Therapy & ASAM):** Multi-level addiction treatment, counseling, psychiatric evaluation, intensive outpatient program (IOP) billing, and 1115 Waiver models. - **Dental:** CDT coding, FQHC dental encounters, and pediatric/adult Medicaid dental guidelines. - **Optometry:** Coordination of vision hardware plans versus medical eye care insurance benefits. - **OB/GYN:** Global OB billing packages, maternal health programs, and state-specific perinatal programs. - Implement best-practice workflows to minimize denials and maximize first-pass claim rates. **Compliance, Audit & Regulatory Oversight** - Ensure full compliance with HRSA Section 330 grant requirements, UDS reporting mandates, PPS guidelines, and sliding fee discount program policies. - Maintain compliance with Federal and State regulations, including HIPAA, CMS guidelines, Medicaid/Medicare billing rules, and behavioral health parity laws. - Partner with the Compliance Officer to design and execute regular internal coding and documentation audits, ensuring any identified vulnerabilities are quickly addressed. - Stay current on state-specific Medicaid Managed Care Organization (MCO) rules and changing reimbursement guidelines. **Team Leadership & Staff Development** - Recruit, train, mentor, and evaluate a high-performing, multi-functional revenue cycle team across multiple departments and clinic sites. - Establish clear performance standards, productivity metrics, and quality expectations for all billing, coding, and RCM support staff. - Foster a collaborative culture of accountability, continuous learning, and professional growth. - Provide continuous training and education to RCM staff and clinical providers on documentation, coding standards, and payer guidelines. **Technology & Electronic Health Record (EHR) Optimization** - Direct the operational optimization and integration of the Epic Electronic Health Records (EHR) and Practice Management (PM) systems. - Evaluate, select, and implement automated RCM tools, clearinghouses, predictive denial management systems, and online patient billing integrations to drive operational efficiency. - Collaborate with IT and clinic leadership to troubleshoot system issues affecting claim submission or charge capture. **Payer Relations, Contracting & Credentialing** - Maintain and cultivate strategic relationships with key payers, including Medicaid MCOs, Medicare, commercial insurers, and state/county funding agencies. - Oversee the centralized provider credentialing and enrollment process to ensure timely clinician participation and prevent administrative write-offs. - Support contract negotiations by providing comprehensive, data-driven analysis of payer reimbursement performance, denial trends, and contract compliance. **Reporting, Analytics & Business Intelligence** - Develop, maintain, and present comprehensive RCM dashboards and performance reports to executive leadership and the Board of Directors. - Utilize advanced data analytics to perform root-cause analyses on billing denials, underpayments, and lagging accounts receivable. - Ensure accurate financial data reporting to support internal audits, external cost reports, and HRSA/UDS submissions. **Qualifications** **Education/Certifications:** - Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Accounting, or a related field required. Master’s degree (MHA, MBA, or equivalent) is highly preferred. - **Certifications (Preferred):** Professional certification such as Certified Revenue Cycle Professional (CRCP), Certified Professional Biller (CPB), Certified Professional Coder (CPC), or Fellow of the Healthcare Financial Management Association (FHFMA/CHFP). **Experience** - **Leadership Experience:** Minimum of **7–10 years** of progressive revenue cycle experience, with at least **5 years** in a director-level or senior leadership role within a healthcare system. - **Large-Scale Operations:** Proven experience managing RCM in a high-volume setting. - **FQHC/Ambulatory Care Expertise:** Highly preferred. Candidates must demonstrate deep knowledge of the FQHC Prospective Payment System (PPS) reimbursement, Sliding Fee Discount Program rules, and HRSA guidelines. - **Specialized Service Lines:** Direct experience overseeing billing/coding for behavioral health (specifically including ASAM/SUD treatment) alongside traditional medical, dental, and optometry services. **Knowledge, Skills & Abilities** - Comprehensive mastery of electronic billing systems, clearinghouses, and practice management databases. - In-depth understanding of CPT, ICD-10-CM, CDT, and DSM-5 coding conventions. - Exceptional analytical, problem-solving, and financial forecasting skills. - Strong interpersonal and communication skills, with the ability to influence positive change across clinical, operational, and financial teams. - Absolute commitment to the mission of providing high-quality healthcare to underserved, vulnerable, and diverse patient populations. ### Why You’ll Love Working Here - **Purpose-driven work** that directly impacts access to care across our communities - **Robust benefits package** (medical, dental, vision) designed to support you and your family - **Generous PTO** because we believe caring for others starts with caring for yourself - **401(k) with employer contribution** to help you plan for what’s ahead - **Life and disability coverage** for peace of mind Here, you are not just filling a role—you are helping shape healthier communities and advancing equitable care every day!