Director of Revenue Cycle Management

Director Of Revenue Cycle Management

The Director of Revenue Cycle is responsible for the strategic oversight and operational management of all revenue cycle functions within the FQHC environment. This role leads efforts related to patient revenue optimization, billing operations, coding compliance, risk-adjustment initiatives, claims management, payer relations, and reimbursement performance. The Director collaborates 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 and analyze key revenue cycle metrics including 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 applicable regulatory standards.
• Oversee coding compliance and risk-adjustment capture (HCC) efforts in collaboration with providers and coding staff.
• Manage relationships and accountability 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 clinical and operational 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 when necessary.
• 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 activities related to patient revenue.
• Supervise, mentor, and evaluate revenue cycle staff while fostering accountability and professional development.
• Maintain confidentiality and ensure compliance with HIPAA and organizational policies.

Qualifications:

• Bachelor's degree in healthcare administration, business, finance, health information management, or related field preferred; equivalent experience may be considered.
• Minimum of 5 years of progressive revenue cycle experience in healthcare required.
• Minimum of 2 years of leadership or supervisory experience required.
• 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:

• Experience in a Federally Qualified Health Center (FQHC) strongly preferred.
• Certified Professional Coder (CPC), Certified Revenue Cycle Representative (CRCR), Certified Coding Specialist (CCS), or 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.

Equal Employment Opportunity/Drug-Free Workplace: The HealthCare Connection is focused on creating a community that promotes dignity and respect for employees, patients and other community members. THCC is an Equal Opportunity Employer and a Drug-Free Workplace. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, military status or other characteristics protected by law and will not be discriminated against based on disability. THCC will only employ those who are legally authorized to work in the United States. Any offer of employment is conditioned upon the successful completion of a background check and a drug screen.