Revenue Cycle Manager

Job Description

Job Description

The Revenue Cycle Manager provides analytical and operational support for the Marin City Health and Wellness Center (MCHWC). This role serves as a central liaison between MCHWC and external revenue cycle partners, to ensure seamless operational integration.

Key Responsibilities include but not limited to:

• Act as the primary point of coordination between MCHWC and external billing/collections partners.
• Ensure alignment of revenue cycle practices across the MCHWC, with emphasis on billing, A/R follow-up, and cash management processes.
• Provide guidance to MCHWC leadership on optimization opportunities and best practices.

Accounts Receivable Analysis & Reporting

• Produce and interpret A/R performance reports using Siemens MedSeries4, Epic, and other relevant systems.
• Identify trends, bottlenecks, and accounts requiring further investigation or escalation.
• Regularly present findings and performance metrics to MCHWC leadership, with recommendations for improvement.

Cash Reconciliation & EDI Support

• Support cash posting, reconciliation, and electronic data interchange (EDI) activities for the MCHWC.
• Collaborate frequently with external banking partners, MCHWC Accounting, Joint Venture Finance, and third-party payers.
• Support vendor oversight to ensure accurate payment processing and data exchange.

Subject Matter Expertise

• Serve as a subject matter expert on revenue cycle operations for MCHWC.
• Provide insight on system optimization, operational efficiencies, and overall revenue cycle strategy for MCHWC.
• Support and maintain Epic Contract Management functionality, including validation of contract terms, fee schedules, reimbursement logic, and payor configuration.
• Apply working knowledge of managed care contract language (e.g., fee-for-service, case rates, DRG methodologies, carve-outs, stop-loss provisions) to ensure correct expected reimbursement and escalation of variances.

MCHWC Business Partners & Compliance Responsibilities

• Coordinate with specialized vendors and business partners unique to the MCHWC, including legacy system operators, contracted billing vendors, joint venture partners, and state/government reimbursement programs.
• Review, implement, and monitor revenue cycle requirements.
• Ensure that all applicable reporting, community benefit billing requirements, pricing guidelines, and patient access provisions are reflected in operational processes, revenue cycle workflows, and vendor performance metrics.
• Communicate compliance updates and risks to MCHWC leadership, recommending corrective actions and process improvements.

Department Description

Patient Financial Services manages revenue cycle functions for the Federally Qualified Health Center, including system billing, reporting, and support. Staff ensure that account information contains accurate and comprehensive data to provide timely billing and optimal reimbursement for services. Timely data validation and account follow-up are important steps in the collection process. PFS revenue cycle emphasizes interdepartmental collaboration, technology, and patient satisfaction. Impacts processes to include insurance identification, data entry, billing, payment posting, refund processing, collections, and customer services. PFS activities generate the net revenue and financial data in support of the organization's goals.

Required Qualifications

• Five years of relevant progressive experience.
• Bachelor's degree in a related area OR four years of equivalent experience/training.
• Advanced knowledge of financial or accounting concepts, policies and procedures, as well as related accounting and regulatory compliance requirements.
• Advanced skills in the use of spreadsheet and database software.
• May require analytical skills sufficient to develop and implement financial data management and reporting systems.
• Strong interpersonal skills and ability to work effectively across the organization at all levels.
• Advanced knowledge and understanding of internal control practices and their impact on protecting resources.
• Skills include service orientation, ability to multitask effectively in a varied, high-volume environment; uses sound judgment and decision making, critical thinking, creative problem solving, and effective verbal and written communication skills.
• Knowledge of Federally Qualified Health Center billing workflows, including but not limited to: insurance billing requirements, ICD/CPT4/HCPC/DRG codes.

Preferred Qualifications

• Advanced knowledge of MCHWC organization and systemwide financial processes and procedures.
• May require skills in project management, leadership, and process re-design.
• Advanced leadership skills to provide guidance, coaching and mentoring to professional and support staff.
• Microsoft Office.
• Epic Certification.

L anguage Skill:

• Excellent oral and written communication skills. 
• Ability to communicate with staff at all levels of MCHWC, in addition to all patients. 
• Must be able to write and communicate program’s successes to diverse audiences.

Reasoning ability:  

• Ability to solve practical problems and deal with a variety of concrete variable in situations where only limited standardization exists. 
• Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. 
• Strong ability to organize, plan, track and report. 
• Must be able to effectively manage multiple projects in a timely manner and frequently make expedited adjustments when necessary. 
• Must possess critical thinking and data analysis skills.

Equipment/Machinery: Fax machine, copier, personal computer, telephone, calculator, Microsoft Word/Excel, EHR system and other software as required.

PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an individual to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Stand and walk or sit alternatively depending on specific needs of day. Estimate 20% of time is spent on feet and 80% sitting at desk.
2. Have occasional need to perform the following physical activities: bend/stoop/squat, climb stairs, push or pull, reach above shoulders.
3. Have occasional need to perform standing and walking activities.
4. Constant need to perform the following physical activities: writing/typing, grasping/turning, finger dexterity.
5. Lifting/carrying over 10 pounds occasionally. Lifting/carrying less than 10 pounds frequently.
6. Vision requirements: constant need to complete forms, read reports, view computer screen.  Frequent need to see small detail.  Frequent need to see things clearly beyond arm's reach.
7. Hearing requirements: constant need to communicate over telephone and in person.

TRAVEL REQUIREMENTS: Frequent need to utilize personal transportation to conduct site visits, and attend meetings and events.

Work Environment:

The noise level in the work environment is usually moderate.