Director of Revenue Cycle

Job description

Planned Parenthood of Western Pennsylvania (PPWP) is a not-for-profit family planning agency that provides high-quality, affordable reproductive health care. Our mission is to enable all Pennsylvanians to have access to a wide range of high-quality, affordable reproductive health care services. We help individuals make informed decisions about their reproductive health, family planning options, and sexuality. We're looking for someone excited to expand a department, solve critical problems and support strategic growth of our care and services in the region. Change agents with a willingness to innovate and a foundational belief that providers like Planned Parenthood stand in the gap of our existing healthcare systems will thrive in this role. Successful candidates will bring a deep compassion for patients, strong analytical skills and systems-level thinking to the position. ### Essential Functions Revenue Cycle Operations Management - Direct, evaluate and optimize all billing and revenue cycle activities for PPWP, including management of staff, and oversight of revenue cycle activities. Financial Performance and Analytics - Develop and maintain reporting and dashboards to monitor key revenue cycle metrics including AR days, denial rates, clean claim rates, collections performance, and payer-specific trends. - Prepare and present revenue cycle performance reviews to executive leadership. Coding Compliance and Education - Develop and deliver clinical billing and training content for providers and clinical front-end users; coordinate with Medical Services leadership to ensure consistent coding and documentation practices across the organization. - Act as the primary liaison between the billing department and internal departments ensuring clear communication, updates to billing processes and procedures, identification of trends, issue resolution, and continuous workflow improvement - Collaborate with Health Center Managers and Medical Services leadership to optimize front-end revenue cycle processes including patient registration, insurance verification, eligibility checking, sliding fee scale application, and point-of-service collections Auditing Compliance and Grants Support - Ensure all billing activities comply with federal and state regulations, HIPAA privacy and security requirements, payer contract terms, and Planned Parenthood’s organizational standards and mission - Collaboratively review the coding audits with operations and IT analysts to identify training and system enhancements to improve compliant billing and coding. - Support billing and documentation requirements for the Title X Family Planning Program, including sliding fee scale compliance, service coding, and federal reporting obligations Payer Relations and Contract Management Support - Direct third-party payer contract negotiations, management, and payer relations, including MCO contracts, fee schedule reviews, and dispute resolution. - Ensure complete, accurate, and timely data is maintained in Epic and that internal operations supports clean claim submission; identify and resolve data or workflow gaps that impact billing performance Strategy and Special projects - Actively participate in strategic discussions and planning activities in collaboration with the Chief Financial Officer and Chief Executive Officer. - Manage Revenue Cycle Work Plan and actively execute various projects and initiatives identified in prior Revenue Cycle assessments, approved work plan and identified priorities. - Manage the risk assessment and quality management process and activities of the Revenue Cycle, including the following: - - Revenue optimization initiatives and needs for PPWP team - Evaluation of risk areas, including mitigation of identified risks - Actively participate in any financial and other compliance audits, specifically related to Revenue Cycle. - Liaise with other PA affiliates to strategize state-wide revenue enhancement Staff Leadership and Development - Recruit, onboard, develop, and retain a small revenue cycle team; set clear performance expectations and conduct regular performance evaluations - Foster a culture of accountability, continuous improvement, and mission alignment within the revenue cycle function - Perform other duties as assigned by the Chief Financial Officer ### Education and Experience | | | | --- | --- | | **Education:** | Bachelor’s degree in Accounting, Finance, Healthcare Administration, Business, or a related field preferred; equivalent combination of experience and education considered. | | **Experience:** | Minimum of three (3) years in a leadership or director-level role Minimum of two (2) years of direct, hands-on experience with Epic Resolute Professional Billing required. Experience in reproductive health, family planning, community health center (FQHC), or women’s health settings strongly preferred | ### Knowledge, Skills and Abilities Epic & Technology - Expert-level working knowledge of Epic Resolute Professional Billing, including claim submission, work queue management, ERA/EOB processing, RTE, and reporting tools - Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data modeling) - Familiarity with clearinghouse platforms (e.g., Availity, Change Healthcare/Optum) and electronic claim submission processes Coding & Compliance ` - Thorough knowledge of CPT, ICD-10-CM/PCS, and HCPCS Level II coding, with specific familiarity with reproductive health service coding including contraceptive management, family planning, and abortion services - Strong understanding of federal and state Medicaid programs, Medicaid MCO billing requirements, and managed care contract structures - Knowledge of Title X program billing requirements, sliding fee scale regulations, and federal family planning service documentation standards - Familiarity with HIPAA privacy and security regulations and their application to billing, data sharing, and vendor management - Understanding of value-based payment models and quality-based incentive structures as they affect revenue cycle operations Leadership & Communication - Proven ability to lead, develop, and motivate a diverse team in a multi-site, mission-driven healthcare environment - Excellent analytical, strategic, and problem-solving skills; ability to translate complex data into clear, actionable insights for executive and clinical audiences - Strong oral and written communication skills; able to present ideas convincingly and concisely to both technical and non-technical stakeholders - Strong commitment to reproductive health equity, patient-centered care, and Planned Parenthood’s mission and values - Well organized with demonstrated ability to manage competing priorities, set timelines, and drive results - Ability and willingness to travel to affiliate health center locations as needed