Director of Revenue Cycle (5973)

Job Details Job Details: Job Location: Administrative Offices Seventh Street - Berkeley, CA 94710, Position Type: Full Time, Education Level: Not Specified, Salary Range: $145,000.00 - $170,000.00 Salary/year, Job Category: Finance, LifeLong Medical Care has an exciting opportunity for a Director of Revenue Cycle to provides strategic and operational leadership for LifeLong Medical Care’s billing and revenue cycle functions, ensuring accurate, timely, compliant billing and optimal collection of patient service revenue across a multi-site Federally Qualified Health Center (FQHC). The Director oversees claims management, accounts receivable, denial prevention and resolution, payment posting, collections, payer reimbursement and billing system integrity. In partnership with the Head of Finance and clinical, operational, compliance, accounting and technology leaders, this role establishes performance goals, strengthens workflows and internal controls, and drives sustainable revenue cycle improvements. About us As a Federally Qualified Health Center in Northern California with over 50 years of dedicated service to the community, LifeLong serves over 66,000 patients in the East Bay Area's socio-economically underserved regions. We provide medical, dental, behavioral health, and school-based services at more than 15 primary care sites across Oakland, Berkeley, and West Contra Costa County. From opening a residential respite program for homeless persons discharged from hospital to offering free testing to the community, we are innovative and responsive to our times' social and medical needs. We provide an inclusive workplace that promotes and values diversity and with which our patients can identify. To this end, we seek candidates who reflect the diversity of the East Bay communities we serve. Benefits We offer a competitive annual salary of $145,000 - $170,000, and excellent benefits: medical, dental, vision, Flexible Spending Accounts, dependent and domestic partner coverage, 403(b) retirement savings plan. Job Duties Lead day-to-day billing and revenue cycle operations, including charge capture, claim edits and submission, follow-up, payment posting, credit balances, refunds, collections and account resolution. Develop and execute revenue cycle strategies to improve clean-claim rates, reduce denials and aged accounts receivable, accelerate cash collections, and maximize appropriate reimbursement. Oversee payer-specific billing and reimbursement requirements, including Medicare, Medi-Cal, FQHC prospective payment system (PPS), managed care, commercial insurance, IPAs and other third-party payers. Monitor claim rejections, denials, underpayments and payer trends; lead root-cause analysis, appeals, recovery efforts and corrective action plans in partnership with relevant teams. Establish and report key performance indicators, including days in A/R, aging by payer, net collection rate, denial rate, clean-claim rate, charge lag, cash posting and productivity; provide regular reports and recommendations to the Head of Finance. Partner with clinical and health center operations to improve registration, insurance verification, eligibility, documentation, charge capture, coding workflows and handoffs that affect billing outcomes. Coordinate with Accounting to support accurate and timely reconciliation of patient revenue, payments, contractual adjustments, refunds, cash receipts and month-end reporting. Maintain compliance with applicable federal and state billing rules, payer contracts, privacy requirements, internal policies and fraud, waste and abuse safeguards; support audits, investigations and remediation. Develop, implement and maintain billing policies, standard operating procedures, training, quality assurance reviews, segregation of duties and internal controls. Oversee practice management and billing system workflows and data integrity; collaborate with IT, EHR teams and vendors to resolve issues, test enhancements and improve automation. Prepare and manage departmental budgets, staffing plans, vendor relationships and operating expenses; review and approve refunds and adjustments within delegated authority. Recruit, supervise, coach, evaluate and develop billing and patient accounts leaders and staff; establish clear productivity, quality and accountability expectations. Participate in organizational strategic planning, cross-functional initiatives, committees and external payer discussions as assigned. Ensure appropriate retention, security and disposition of billing and patient financial records; perform other related duties as assigned. Other duties as assigned. Qualifications Commitment to the provision of primary care services for the underserved with demonstrated ability and sensitivity in working with a variety of people from low-income populations, with diverse educational, lifestyle, ethnic and cultural origins. Strong ability to work independently and make sound judgments within established guidelines; understand and apply oral and written instructions; establish and maintain effective working relations with staff, clinical providers, managers and external agencies or organizations. Ability to effectively supervise staff, encourage and nurture development and growth, to build a strong and productive team. Strong organizational, administrative and problem-solving skills, and ability to be flexible and adaptive to change. Ability to understand, interpret, and apply instructions, policies and procedures as related to recording of patient information, enrollment and reimbursement. Ability to effectively present information to others, including other employees, community partners and vendors. Ability to work with individuals and organizations at the local level to build support. Work in a team-oriented environment with a number of professionals with different work styles and support needs. Excellent interpersonal, verbal, and written skills. Conduct oneself in internal and external settings in a way that reflects positively on Life Long Medical Care as an organization of professional, confident and sensitive staff. Ability to see how one’s work intersects with that of other departments of Life Long Medical Care and that of other partner organizations. Make appropriate use of knowledge/ expertise/ connections of other staff. Be creative and mature with a “can do”, proactive attitude and an ability to continuously “scan” the environment, identifying and taking advantage of opportunities for improvement. Requirements Bachelor’s degree in healthcare administration, business, finance or a related field, or an equivalent combination of education and relevant experience. At least five years of progressively responsible healthcare billing or revenue cycle experience, including at least three years of supervisory or management experience. Demonstrated knowledge of FQHC billing and reimbursement, Medicare, Medi-Cal, managed care, third-party payer requirements and billing compliance. Experience managing accounts receivable, denials, collections, billing performance metrics, process improvement and financial reporting. Proficiency with practice management/EHR systems, Microsoft Office applications and revenue cycle reporting tools. Preferences Master’s degree in healthcare administration, business or a related field. Experience leading revenue cycle operations in a multi-site community health center or FQHC. Experience with Epic, eClinicalWorks or comparable enterprise practice management systems. Professional revenue cycle, billing or coding certification. Supervision This position has direct staff supervisory responsibilities: Patient Accounts Manager Physical Demands and Work Environment The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to stand, walk, and sit; use hands to finger, handle, or feel and reach with hands and arms; talk and hear. The employee must occasionally lift and/or move up to 25 pounds. The employee frequently works with a video display terminal for prolonged periods; vision abilities include close vision and ability to adjust focus. While performing the duties of this job, the employee regularly works in inside environmental conditions. The employee may be required to attend evening meetings, travel and work evenings or weekends. The noise level is usually quiet. Individual is subject to frequent interruptions. #J-18808-Ljbffr Lifelong Medical Care