Director of Renevue Cycle & Reimbursement

Director of Renevue Cycle & Reimbursement 3.3 3.3 out of 5 stars 15093 South Sunland Gin Road, Arizona City, AZ 85123 Hybrid work $85,000

• $105,000 a year
• Full-time Desert Senita Community Health Center 3 reviews $85,000
• $105,000 a year
• Full-time Job Summary Under the direction of the Chief Financial Officer (CFO), the Director of Revenue Cycle & Reimbursement is responsible for the strategic leadership, administration, oversight, and continuous improvement of all revenue cycle operations for the organization.

This role directs and coordinates all functions related to patient registration, eligibility verification, coding, charge capture, claims management, payment posting, accounts receivable follow-up, denials management, collections, and reimbursement optimization across all service lines and billable disciplines. The Director ensures the integrity, compliance, and financial performance of the revenue cycle while supporting the mission of a Federally Qualified Health Center (FQHC) and maintaining compliance with federal, state, payer, and regulatory requirements. The position works collaboratively with executive leadership, clinical operations, finance, compliance, quality improvement, credentialing, human resources, and practice management teams to improve operational efficiency, maximize reimbursement, reduce denials and bad debt, and strengthen organizational financial sustainability. Oversees and manages outsourced revenue cycle vendors, including the organization's partnership with NextGen Healthcare Revenue Cycle Management services, ensuring accountability, performance standards, compliance, payment integrity, operational efficiency, and achievement of organizational financial goals. This position requires strong leadership, analytical, operational, and communication skills, as well as expertise in FQHC reimbursement methodologies, Medicaid and Medicare regulations, value-based reimbursement models, and healthcare compliance standards. Responsibilities

• Revenue Cycle Leadership & Operations Direct and oversee all functions of the revenue cycle, including: Patient registration and insurance verification Charge capture and coding Claims submission and management Payment posting and reconciliation Denials management and appeals Accounts receivable follow-up Patient collections and bad debt management Ensure timely and accurate billing for all clinical and ancillary services in accordance with payer, federal, and state regulations.

Monitor revenue cycle performance and implement strategies to improve cash flow, reduce denials, minimize aging accounts receivable, and optimize reimbursement. Develop, implement, and maintain standardized revenue cycle workflows and operational procedures across all departments and clinic locations. Collaborate with operational and clinical leadership to improve front-end processes impacting reimbursement, including registration accuracy, insurance eligibility verification, demographic collection, and documentation integrity. Oversee all internal revenue cycle staff and external billing vendors or contractors. Manage and oversee third-party revenue cycle vendors, clearinghouses, payment processors, and outsourced billing partners, including NextGen Healthcare Revenue Cycle Management services. Monitor vendor performance through established service-level agreements (SLAs), key performance indicators (KPIs), denial trends, collection performance, accounts receivable aging, and cash reconciliation processes. Collaborate with outsourced revenue cycle partners to ensure timely claim submission, payment posting, denial resolution, payer follow-up, and compliance with federal, state, payer, and FQHC billing requirements. Serve as the primary organizational liaison between internal leadership teams and outsourced revenue cycle vendors to support operational alignment, issue resolution, workflow optimization, and continuous process improvement. Conduct routine audits and operational reviews of vendor performance, billing accuracy, coding practices, reimbursement trends, and compliance activities. Coordinate with Finance, Compliance, Information Technology, and Operations teams regarding system interfaces, reporting accuracy, payment reconciliation, and revenue integrity processes involving outsourced revenue cycle vendors.

• FQHC Billing & Regulatory Compliance Maintain expertise in FQHC Prospective Payment System (PPS), Medicare, Medicaid, managed care, commercial insurance, and other third-party payer reimbursement methodologies.

Ensure organizational compliance with:

Health Resources and Services Administration requirements Federal Tort Claims Act (FTCA) documentation expectations Office of Inspector General (OIG) guidance HIPAA regulations CMS billing and documentation requirements State and federal healthcare regulations Oversee billing compliance activities, internal audits, and corrective action initiatives in collaboration with the CFO and Compliance Department. Develop and maintain a formal Revenue Cycle Compliance and Audit Program. Ensure timely identification, investigation, reporting, and resolution of billing compliance issues or payer audit findings. Monitor and communicate regulatory and payer policy changes affecting reimbursement and operational processes.

• Financial Performance & Reporting Develop and monitor key revenue cycle performance indicators (KPIs), including: Days in Accounts Receivable (A/R) Net Collection Rate Clean Claim Rate Denial Rate Aging A/R Bad Debt Percentage Charge Lag Payment Lag Encounter Closure Timeliness Prepare and present monthly operational and financial reports to executive leadership.

Analyze trends, identify operational risks, and recommend corrective action plans to improve financial outcomes. Support budgeting, forecasting, payer analysis, and revenue optimization initiatives.

• Contracting & Reimbursement Strategy Collaborate with executive leadership and finance teams regarding payer contract analysis, reimbursement methodologies, and contract negotiations.

Review insurance payer contracts and recommend revisions to improve reimbursement terms and operational efficiency. Identify reimbursement opportunities and operational risks associated with: Value-based payment models Accountable Care Organizations (ACOs) Quality incentive programs Alternative payment methodologies

• Systems, Process Improvement & Training Oversee revenue cycle functionality within the Electronic Health Record (EHR) and practice management systems.

Partner with Information Technology and operational leadership to optimize system workflows, reporting, automation, and billing functionality. Develop and implement process improvement initiatives addressing gaps in systems, workflows, staffing, training, and operational performance. Develop and maintain revenue cycle policies and procedures. Provide education and ongoing training to clinical, operational, and billing staff regarding documentation, coding, billing compliance, and payer requirements.

• Leadership & Staff Development Supervise, mentor, and evaluate revenue cycle staff and departmental leadership.

Conduct performance evaluations and implement coaching, corrective action, and professional development plans as needed. Promote a culture of accountability, collaboration, customer service, compliance, and continuous improvement. Support workforce planning, recruitment, onboarding, and retention initiatives within the Revenue Cycle Department.

• Other Duties Participate in organizational committees, quality improvement initiatives, and strategic planning activities. Perform other duties as assigned by executive leadership.
• Required Qualifications Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field required.

Minimum of five (5) years of progressive leadership experience in healthcare revenue cycle management required. Minimum of three (3) years of leadership experience in an FQHC, community health center, rural health clinic, or similar ambulatory healthcare setting preferred.

Demonstrated knowledge of:

FQHC billing and reimbursement methodologies Medicare and Medicaid regulations Managed care billing and contracting CPT, ICD-10, and HCPCS coding Healthcare compliance and audit practices Revenue cycle analytics and KPI reporting Experience managing EHR and practice management billing systems. Experience with payer audits, denials management, appeals, and reimbursement recovery initiatives. Strong knowledge of value-based reimbursement and quality incentive programs preferred. Experience working with NextGen Healthcare Revenue Cycle Management services or similar outsourced healthcare billing organizations preferred. Preferred Certifications One or more of the following certifications preferred: Certified Professional Coder (CPC) Certified Coding Specialist (CCS) Certified Revenue Cycle Representative (CRCR) Certified Healthcare Financial Professional (CHFP) Certified Medical Practice Executive (CMPE) Core Competencies Strategic Leadership Revenue Cycle Optimization Financial Analysis & Reporting Regulatory Compliance Process Improvement Operational Excellence Staff Development & Coaching Critical Thinking & Problem Solving Communication & Relationship Management Change Management Project Management Data-Driven Decision Making Customer Service & Patient-Centered Care Physical & Work Requirements Ability to sit, stand, walk, and use standard office equipment for extended periods. Ability to communicate effectively in person, virtually, and in writing. Occasional travel between clinic locations may be required. Work Environment This position operates in a professional healthcare and office environment supporting a mission-driven community health center organization dedicated to providing accessible, high-quality healthcare services to underserved populations.

Pay:

$85,000.00

• $105,000.

00 per year

Benefits:

Dental insurance Employee assistance program Flexible schedule Health insurance Health savings account Life insurance Paid time off Retirement plan Vision insurance

Experience:

FQHC:

3 years (Required) Ability to

Commute:

Arizona City, AZ 85123 (Required)

Work Location:

Hybrid remote in Arizona City, AZ 85123