Director of Revenue Cycle

Revenue Cycle Operations Manager

Planned Parenthood of Western Pennsylvania (PPWP) is a not-for-profit family planning agency that provides high-quality, affordable reproductive health care. Our mission is to enable all Pennsylvanians to have access to a wide range of high-quality, affordable reproductive health care services. We help individuals make informed decisions about their reproductive health, family planning options, and sexuality.

We're looking for someone excited to expand a department, solve critical problems and support strategic growth of our care and services in the region. Change agents with a willingness to innovate and a foundational belief that providers like Planned Parenthood stand in the gap of our existing healthcare systems will thrive in this role. Successful candidates will bring a deep compassion for patients, strong analytical skills and systems-level thinking to the position.

Essential Functions

• Revenue Cycle Operations Management
• Financial Performance and Analytics
• Coding Compliance and Education
• Auditing Compliance and Grants Support
• Payer Relations and Contract Management Support
• Strategy and Special Projects
• Staff Leadership and Development

Revenue Cycle Operations Management

• Direct, evaluate and optimize all billing and revenue cycle activities for PPWP, including management of staff, and oversight of revenue cycle activities.

Financial Performance and Analytics

• Develop and maintain reporting and dashboards to monitor key revenue cycle metrics including AR days, denial rates, clean claim rates, collections performance, and payer-specific trends.
• Prepare and present revenue cycle performance reviews to executive leadership.

Coding Compliance and Education

• Develop and deliver clinical billing and training content for providers and clinical front-end users; coordinate with Medical Services leadership to ensure consistent coding and documentation practices across the organization.
• Act as the primary liaison between the billing department and internal departments ensuring clear communication, updates to billing processes and procedures, identification of trends, issue resolution, and continuous workflow improvement
• Collaborate with Health Center Managers and Medical Services leadership to optimize front-end revenue cycle processes including patient registration, insurance verification, eligibility checking, sliding fee scale application, and point-of-service collections

Auditing Compliance and Grants Support

• Ensure all billing activities comply with federal and state regulations, HIPAA privacy and security requirements, payer contract terms, and Planned Parenthood's organizational standards and mission
• Collaboratively review the coding audits with operations and IT analysts to identify training and system enhancements to improve compliant billing and coding.
• Support billing and documentation requirements for the Title X Family Planning Program, including sliding fee scale compliance, service coding, and federal reporting obligations

Payer Relations and Contract Management Support

• Direct third-party payer contract negotiations, management, and payer relations, including MCO contracts, fee schedule reviews, and dispute resolution.
• Ensure complete, accurate, and timely data is maintained in Epic and that internal operations supports clean claim submission; identify and resolve data or workflow gaps that impact billing performance

Strategy and Special Projects

• Actively participate in strategic discussions and planning activities in collaboration with the Chief Financial Officer and Chief Executive Officer.
• Manage Revenue Cycle Work Plan and actively execute various projects and initiatives identified in prior Revenue Cycle assessments, approved work plan and identified priorities.
• Manage the risk assessment and quality management process and activities of the Revenue Cycle, including the following:
• Revenue optimization initiatives and needs for PPWP team
• Evaluation of risk areas, including mitigation of identified risks
• Actively participate in any financial and other compliance audits, specifically related to Revenue Cycle.
• Liaise with other PA affiliates to strategize state-wide revenue enhancement

Staff Leadership and Development

• Recruit, onboard, develop, and retain a small revenue cycle team; set clear performance expectations and conduct regular performance evaluations
• Foster a culture of accountability, continuous improvement, and mission alignment within the revenue cycle function
• Perform other duties as assigned by the Chief Financial Officer

Education and Experience

Education: - Bachelor's degree in Accounting, Finance, Healthcare Administration, Business, or a related field preferred; equivalent combination of experience and education considered.

Experience: - Minimum of three (3) years in a leadership or director-level roleMinimum of two (2) years of direct, hands-on experience with Epic Resolute Professional Billing required.Experience in reproductive health, family planning, community health center (FQHC), or women's health settings strongly preferred

Knowledge, Skills and Abilities

Epic & Technology

• Expert-level working knowledge of Epic Resolute Professional Billing, including claim submission, work queue management, ERA/EOB processing, RTE, and reporting tools
• Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data modeling)
• Familiarity with clearinghouse platforms (e.g., Availity, Change Healthcare/Optum) and electronic claim submission processes

Coding & Compliance

• Thorough knowledge of CPT, ICD-10-CM/PCS, and HCPCS Level II coding, with specific familiarity with reproductive health service coding including contraceptive management, family planning, and abortion services
• Strong understanding of federal and state Medicaid programs, Medicaid MCO billing requirements, and managed care contract structures
• Knowledge of Title X program billing requirements, sliding fee scale regulations, and federal family planning service documentation standards
• Familiarity with HIPAA privacy and security regulations and their application to billing, data sharing, and vendor management
• Understanding of value-based payment models and quality-based incentive structures as they affect revenue cycle operations

Leadership & Communication

• Proven ability to lead, develop, and motivate a diverse team in a multi-site, mission-driven healthcare environment
• Excellent analytical, strategic, and problem-solving skills; ability to translate complex data into clear, actionable insights for executive and clinical audiences
• Strong oral and written communication skills; able to present ideas convincingly and concisely to both technical and non-technical stakeholders
• Strong commitment to reproductive health equity, patient-centered care, and Planned Parenthood's mission and values
• Well organized with demonstrated ability to manage competing priorities, set timelines, and drive results
• Ability and willingness to travel to affiliate health center locations as needed

$90,000 - $100,000 a year

Planned Parenthood of Western Pennsylvania is an equal employment opportunity employer and is committed to maintaining a non-discriminatory work environment, and does not discriminate against any employee or applicant for employment on the basis of race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity, or any other characteristic protected by applicable law. PPWP is committed to creating a dynamic work environment that values diversity and inclusion, respect and integrity, customer focus, and innovation.