FQHC Billing Account Manager

FQHC Billing Account Manager - Santa Fe Springs, CA

Compensation: $28.00 per hour

Overview: Nexus HR is seeking an experienced RCM Billing Account Manager. The ideal candidate will have a strong background in FQHC medical billing, revenue cycle management, and coding compliance. This role requires deep knowledge of payer regulations and reimbursement models, as well as leadership experience managing billing teams. Strong communication, analytical, and organizational skills are essential for success in this position.

About the Job

The RCM Billing Account Manager is responsible for overseeing all aspects of Revenue Cycle Management (RCM), including billing operations, coding compliance, claims submission, denial management, and reimbursement optimization for FQHC clients. The role involves managing assigned accounts, supervising billing teams, and reporting directly to the RCM Division Manager. The schedule is Monday through Friday, 8:30 AM to 4:30 PM Pacific Standard Time, and will work on-site at the client's office as a representative. 

Duties and Responsibilities:

• Oversee end-to-end billing and RCM operations for assigned FQHC accounts

• Communicate with clients and respond to inquiries within one business day

• Serve as a trusted advisor on FQHC billing rules, UDS reporting, wraparound payments, PPS/APM reimbursement models, sliding fee schedules, and Medicaid/Medicare billing

• Monitor key RCM metrics such as clean claim rate, days in A/R, denial trends, and collection performance

• Conduct monthly or quarterly business reviews (QBRs) with clients

• Collaborate with internal billing teams and clearinghouses to ensure accurate claims submission, payment posting, and denial resolution

• Ensure compliance with HRSA, CMS, and payer-specific billing guidelines

• Maintain knowledge of state Medicaid programs and managed care plans

• Create dashboards and KPI reports to track AR aging, charge lag, clean claim rate, and payment trends

• Lead and manage billing staff, set goals, delegate tasks, monitor performance, and training 

• Ensure accurate and compliant coding practices following CPT, ICD-10, and HCPCS guidelines

• Develop transition plans for team changes and support onboarding of new clients/projects

Qualifications :

• Minimum of 3 years of FQHC medical billing experience and 3 years of management experience

• Associate’s or Bachelor’s degree preferred (or equivalent experience)

• CPC (Certified Professional Coder) required

• Strong leadership, client communication, KPI reporting, and RCM process optimization skills

• Extensive knowledge of FQHC billing regulations, Medicaid/Medicare billing, PPS/APM reimbursement models, HRSA, and CMS guidelines

• English proficiency required

• Must be authorized to work in the United States

Benefits:

• 401(k)

• Medical Insurance

• Dental Insurance

• Vision Insurance

• Paid Time Off (PTO)