Director of Revenue Cycle

Director Of Revenue Cycle

Under the direction of the Chief Financial Officer (CFO), the Director of Revenue Cycle provides strategic and hands-on leadership for all FQHC revenue cycle operations. The role is directly responsible for closely monitoring accounts receivable, driving measurable improvements in collection rates, and implementing ongoing staff training to ensure billing compliance, denial reduction, and revenue optimization. The Director ensures integration between clinical operations, finance, billing vendors, and payers with deep focus on FQHC-specific requirements including Medicare/Medicaid cost reporting, sliding fee scale, and encounter data integrity. The position has direct supervisory oversight of the Patient Service Representative Supervisor and full responsibility for the Sliding Fee Discount Program and Provider Credentialing.

Supervisory Responsibilities

• Directly supervises the Patient Service Representative (PSR) Supervisor.
• Indirectly oversee PSR staff through the PSR Manager.
• Responsible for performance management, training coordination, and accountability for registration, eligibility, and sliding fee processes.

Essential Duties and Responsibilities

PROVIDER CREDENTIALING & ENROLLMENT

• Manage and oversee the full lifecycle of provider credentialing and enrollment for all billable providers.
• Ensure all providers are credentialed and enrolled with Medicare, Medicaid, and all commercial/managed care payers prior to their start date and maintained current thereafter.
• Coordinate with HR and clinical leadership to onboard new providers, including completion of CAQH, state licenses, DEA, and payer applications.
• Re-credential providers according to payer schedules (typically every 3 years) and ensure no lapse in reimbursement eligibility.
• Investigate and resolve credentialing-related claim denials (e.g., provider not on file, non-participating status) in collaboration with billing staff.
• Ensure timely submission of provider demographic changes (address, NPI, taxonomy practice location) to all payers.

ACCOUNTS RECEIVABLE CLOSE MONITORING

• Perform daily and weekly reviews of AR aging reports by payer (Medicare, Medicaid, Commercial, Self-Pay) and by service (medical, dental, behavioral health and case management).
• Monitor days in accounts receivable (DAR), gross/net collection rates, and percentage of AR> days; present findings to CFO and department leadership.
• Reconcile payer payments to contracts monthly, identifying underpayments, timely filing denials, precertification and pre-authorization denials, and FQHC-specific reimbursement shortfalls.
• Oversee uncollectible account reviews and write-offs approvals in compliance with FQHC sliding scale fee scales policies.

IMPROVING COLLECTION RATES

• Develop and implement strategies to reduce self-pay AR through improved sliding fee scale determination at registration, payment plan options, and follow-up protocols.
• Lead denial management efforts with a focus on top FQHC denial reasons (e.g., missing encounter data, incorrect place of service, missing sliding fee documentation, prior authorization gaps, timely filing).
• Collaborate with the PSR Manager to reduce registration-related collection barriers (e.g., incomplete sliding fee application applications, inaccurate or missing insurance capture, missed self-pay collections at check-in).
• Establish and monitor collection KPIs by provider, site, and payers.

SLIDING FEE DISCOUNT PROGRAM

• Own and administer the organization's Sliding Fee Discount Program in compliance with HRSA FQHC requirements.
• Develop, maintain, and annually update the Sliding Fee Scale Policy, discount tiers, and eligibility criteria.
• Ensure all patients are screened for sling fee eligibility at registration and recertified annually.
• Oversee the accurate processing of sliding fee application, income verification, and discount application within the EMR.
• Conduct quarterly internal audits of sliding fee determinations and discounts applied; correct errors and retained staff as needed.
• Prepare for and support HRSA operational site visits (OSV) related to sliding fee compliance.
• Report sliding fee program metrics (e.g., % of patients screened, % eligible, write-offs by discount levels) to CFO monthly.
• Ensure sliding fee discounts are properly reflected in patient statements and AR write-offs.

TRAINING STAFF (ONGOING)

• Develop and deliver a revenue cycle training curriculum for registration staff (PSRs), billers, and clinical providers, including:
• FQHC billing rules
• Sliding fee scale application, documentation, patient communication, and compliance
• Medicare/Medicaid compliance and cost report data capture
• Denial root cause analysis and prevention strategies
• EMR workflows for charge capture, encounter closure, and registration accuracy
• Provide real-time coaching on denied claims and registration errors; maintain a denial log with assigned corrective training for recurring issues.

ADDITIONAL FQHC-SPECIFIC DUTIES

• Ensure accurate encounter data submission for Medicare/Medicaid cost reports and UDS reporting.
• Monitor regulatory changes (Medicare Physician Fee Schedule, Medicaid FQHC PPS, FQHC billing manual, HRSA sliding guidance) and update internal policies/training accordingly.
• Coordinate with clinical departments to optimize EMR workflows for same-day encounter closure, coding accuracy, and reduction of pre-bill edits.
• Investigate denials trends, communication root cause owners (e.g., registration/PSR Supervisor and clinical), and report findings to leadership.
• Assist providers on documentation rules tied to reimbursement (e.g., medical necessity, qualifying visit criteria for FQHC encounter rate).

LEADERSHIP & ADMINISTRATION

• Attend staff meetings, leadership meetings, external FQHC revenue cycle collaborative sessions and EMR billing meetings.
• Complete special projections as assigned by the CFO.

Minimum Qualifications (Knowledge, Skills, and Abilities) Position requires the minimum of Bachelor's degree in Business Administration, Healthcare Administration or related field preferred. Minimum 3-5 years of healthcare reimbursement experience, with at least 2 years in an FQHC, community health center, or rural health clinic (required). Minimum 3 years of experience with Medicare, Medicaid, and managed care billing in FQHC setting. Minimum 2-3 years of supervisory experience in revenue cycle, billing, or patient financial services. Knowledge of managed care policies. ICD10, and medical terminology preferred. Ability to read, write and communicate effectively orally and in writing.

Outreach Community Health Centers, Inc. is an Equal Opportunity Employer