Director Of Revenue Cycle

The Director of Revenue Cycle provides strategic leadership and operational oversight of all revenue cycle activities for Elevated Community Health (ECH). This position ensures optimized reimbursement, cash flow, regulatory compliance, and the patient financial experience across medical, dental, behavioral health, pharmacy, and enabling services. The Director will lead all aspects of revenue cycle performance, including patient registration, eligibility verification, sliding fee discount program administration, charge capture, coding, billing, accounts receivable, denial management, payment posting, provider credentialing, payer enrollment, revenue cycle analytics, and revenue-related technology systems. The Director directly supervises the Eligibility Manager and Patient Access Manager. They collaborate closely with clinical, operational, compliance, information technology, and finance leadership to achieve organizational financial goals while maintaining compliance with HRSA, Medicare, Medicaid, and commercial payer requirements. The Director will support ECH's Access, Stewardship, and Quality (ASQ) priorities by improving access to care through efficient revenue cycle processes that reduce barriers to services, promoting stewardship through effective revenue cycle operations and financial performance, and enhancing quality through accurate, compliant revenue cycle practices and positive patient financial experience. Essential Functions: Establish organizational goals, KPIs, policies/procedures, and performance improvement initiatives relative to all Revenue Cycle operations. Lead revenue cycle staff development, succession planning, and performance management. Monitor and improve financial performance through revenue cycle optimization. Collaborate with executive leadership to support organizational growth initiatives. Evaluate revenue cycle vendor performance and contracts. Participate in financial forecasting and revenue planning. Oversee provider enrollment and credentialing with Medicare, Medicaid, managed care organizations, and commercial payers. Monitor revalidation and recredentialing activities. Ensure timely enrollment of new providers and locations. Minimize reimbursement delays related to credentialing deficiencies. Provide leadership to the following enrollment and eligibility functions: ECH Patient Assistance Fund Ensure an exceptional patient financial experience. Develop policies supporting financial access and affordability for patients. Monitor self-pay collections and financial assistance processes. Provide leadership to the following patient registration functions: Insurance verification Point-of-service collections Develop and monitor patient registration performance standards related to registration accuracy, eligibility verification, and point-of-service collections. Ensure accurate and timely collection of demographic, insurance, and financial information to support reimbursement, regulatory compliance, and quality reporting. Partner with operational and clinical leaders to improve patient registration processes, reduce registration-related claim denials, and enhance the overall patient experience. Revenue Integrity & Charge Capture Implement controls to ensure complete and accurate charge capture. Partner with providers and operational leaders to improve documentation quality. Monitor encounter closure timeliness and documentation deficiencies. Oversee provider coding education, audits, and compliance monitoring. Analyze missed revenue opportunities and implement corrective measures. Ensure proper use of CPT, HCPCS, ICD-10-CM, CDT, and applicable coding guidelines. Billing, Coding & Collections Oversee all billing operations for medical, dental, and behavioral health services. Ensure compliance with federal, state, payer, and regulatory billing requirements. Ensure timely and accurate claim submission and payment posting. Direct denial prevention, denial recovery, appeals management, and payer dispute resolution. Monitor aging accounts receivable and develop corrective action plans. Review reimbursement trends and recommend operational improvements. FQHC Reimbursement & Compliance Maintain expertise in FQHC reimbursement methodologies. Ensure compliance with HRSA requirements and the Sliding Fee Discount Program. Complete and implement annual fee schedule reviews per policy. Oversee Medicaid and Medicare billing and wraparound payment processes. Support annual Uniform Data System (UDS) reporting requirements. Coordinate revenue cycle-related audits and corrective action plans. Monitor changes in reimbursement regulations and ensure the organization is ready. EHR/EDR Systems Administration Provide leadership and oversight for the organization's practice management and revenue cycle technology systems. Partner with clinical, dental, operations, finance, quality, and IT leaders to ensure systems support efficient workflows, accurate billing, regulatory compliance, and quality patient care. Lead EHR and EDR optimization initiatives to improve documentation, charge capture, coding accuracy, reimbursement, and revenue cycle performance. Oversee system upgrades, workflow changes, and new technology implementations. Oversee vendor relationships for practice management, clearinghouse, and RCM systems. Ensure appropriate user training, change management, and adoption of system best practices. Analytics & Reporting Develop benchmarks and productivity standards across revenue cycle functions. Analyze trends and identify opportunities to improve operations. Provide regular reporting to organizational leadership. Utilize data-driven decision-making to improve financial outcomes. #J-18808-Ljbffr Elevated Community Health