Position Summary:

The Billing Manager directs and coordinates the day-to-day operations of the FQHC billing, coding, and collections department using the athenaOne platform. This role optimizes cash flow, enforces regulatory compliance, and serves as the internal expert on FQHC-specific reimbursement structures, including Pennsylvania's Prospective Payment System (PPS), sliding fee scales, and Pennsylvania Medical Assistance (Medicaid) Managed Care Organization (MCO) guidelines.

Key Responsibilities:

FQHC Operations and Revenue Cycle Management Oversee end-to-end billing operations, charge entry, electronic claim submissions, payment posting, and aged A/R follow up within athenaOne. Manage Pennsylvania PPS rate structures, wrap around payment processes (PROMISe invoicing), and encounter code tracking specific to FQHC environments. Monitor key performance indicators (KPIs) through athenaOne reporting dashboards, including clean claim rates, days in accounts receivable (A/R), and collection percentages. Oversee Sliding Fee Scale application audits to ensure proper alignment with patient tier criteria and HRSA compliance standards. Compliance and Denials Management Ensure strict adherence to HRSA, CMS, HIPAA, and PA Department of Human Services (DHS) Medical Assistance regulations. Leverage athenaOne Claim Rules Engine and denial tracking tools to identify trends from PA Medicaid MCOs (e.g., UPMC For You, AmeriHealth Caritas, Geisinger Health Plan, Keystone First), designing root cause corrective action plans. Maintain up to date knowledge of clinical coding updates (ICD-10, CPT, HCPCS) and ensure provider documentation supports billable encounters. Assist finance leadership with annual PA Medicaid cost reporting and compliance audits. Assist with UDS submission.

Benefits:

401(k) Disability insurance Health insurance Life insurance Paid time off Application Question(s): How many years of billing experience do you have? What are your salary expectations? Are you able to commute to Fredericktown, PA?

Work Location:

In person