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Description

The Revenue Cycle Manager is responsible for overseeing and optimizing the end-to-end revenue cycle processes, a Federally Qualified Health Center (FQHC) that recently implemented the Epic electronic health record (EHR) system and outsources billing operations to a third-party vendor. This role ensures the integrity and performance of revenue capture, claim submission, denial management, and cash posting workflows in coordination with internal departments and external billing partners. The ideal candidate is an experienced revenue cycle leader who understands FQHC reimbursement models and is comfortable navigating Epic in a multi-vendor, collaborative environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Serve as the primary liaison with the outsourced billing vendor to ensure accurate, timely, and compliant claim processing, denial resolution, and collections. Monitor and enforce performance standards, KPIs, and SLAs related to vendor performance.

• Review and escalate vendor issues that impact cash flow or compliance.

• Ongoing process improvement analysis and implementation of system improvements, with a particular focus on prioritization of revenue-by-revenue type.

• Analyze claims data and suggest/implement procedures to maximize UDS/HEDIS and incentive revenue collections (i.e., ICD-10 and CPT modifiers).

• Compile requested statistical, financial, billing, or auditing reports.

• Identifies, analyzes, and addresses challenges and/or breakdowns in the revenue cycle process causing denials or delayed payments.

• Perform ongoing trend analysis of factors impacting revenue, including payer rejections and denials.

• Conduct internal audits and reviews to assess coding accuracy, encounter completeness, and billing documentation.

• Collaborates with Executive, Clinical, Operations, Information Technology, and Compliance teams to integrate and optimize revenue cycle management across functions in the organization

• Work with EHR vendor on Electronic Interchange (EDI) issues and system upgrades to maximize practice management system utilization.

• Collaborate closely with the Finance Department to contribute to cash reconciliation activities and assist in assessing accounts receivable collectability and validation, including the writing off of bad debts.

• Participate in strategic initiatives, quality improvement, and grant reporting projects as needed.

• Perform the review of contracted rates vs. reimbursements.

• Creates and develops reports to address management needs; analyze information to identify trends or issues.

• Implement industry best practices, benchmarks, and tools for reimbursement, denial management, collections, billing, claims, and other Revenue Cycle processes.

• Track key revenue cycle metrics (e.g., days in AR, denial rates, clean claim rate, net collections) and report performance to CFO and leadership.

• Other duties as assigned.

For immediate consideration please call me directly 508-205-2127

Eric Lebow

Requirements

ERP - Enterprise Resource Planning, Accounting Functions, Accounts Receivable (AR), Auditing, HealthCare Revenue Cycle, Hospital Revenue Cycle, ICD-10, Billing Collection, Billing Functions, HealthCare Billing, Hospital Billing, Insurance Billing, Electronic Medical Record, EMR - Electronic Medical Records, EMR (Electronic Medical Records), Certified Epic, Epic EMR, Epic Hospital Billing

For immediate consideration please call me directly 508-205-2127

Eric Lebow

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