Revenue Cycle and Billing Director

Job Description

Job Description

POSITION SUMMARY:

The Revenue Cycle and Billing Director is a key member of the leadership team responsible for the strategic oversight and operational performance of CCI Health Services' revenue cycle. This position provides leadership for patient access, billing, coding, collections, denial management, payer relations, and revenue integrity to ensure accurate, compliant, and timely reimbursement.

The Director partners with Finance, Operations, Clinical Leadership, Compliance, and Information Technology to optimize revenue cycle performance, strengthen internal controls, improve the patient financial experience, and support organizational growth. Experience and subject matter expertise in FQHC/CHC billing, HRSA regulations, Medicare and Medicaid reimbursement, and revenue cycle analytics are strongly preferred.

KEY FUNCTIONS & RESPONSIBILITIES:

• Provides strategic leadership and oversight for all Revenue Cycle operations across the organization.
• Develops, implements, and continuously improves Revenue Cycle strategies that maximize reimbursement, improve operational efficiency, and support organizational goals.
• Serves as the primary point of contact and subject matter expert for Revenue Cycle operations.
• Oversees all Revenue Cycle functions, including patient registration, insurance verification, prior authorization, charge capture, coding, claims submission, payment posting, denial management, patient billing, collections, refunds, and credit balance resolution.
• Ensures timely, accurate, and compliant billing and reimbursement from all governmental and commercial payers.
• Develops, implements, and maintains standardized Revenue Cycle policies, procedures, and workflows.
• Establishes departmental goals and ensures achievement of operational and financial performance targets.
• Identifies opportunities to improve revenue capture, reduce revenue leakage, and optimize reimbursement.
• Monitors key Revenue Cycle performance indicators and develops action plans to improve financial performance.
• Performs root cause analysis of denials, payment variances, and reimbursement trends and implements corrective actions.
• Collaborates with Finance to ensure timely reconciliation between billing systems and the general ledger and supports month-end close activities.
• Ensures compliance with HRSA, CMS, Medicare, Medicaid, commercial payer, and other applicable federal and state billing regulations.
• Maintains expertise in FQHC reimbursement methodologies, including PPS, Sliding Fee Discount Program requirements, and UDS reporting.
• Coordinates Revenue Cycle activities related to external audits, regulatory reviews, and payer audits.
• Leads continuous process improvement initiatives to enhance efficiency, reduce manual processes, and improve patient and staff experience.
• Oversees optimization of Revenue Cycle technology, electronic medical record workflows, clearinghouse functions, reporting tools, and system integrations.
• Evaluates and implements automation and technology solutions to improve Revenue Cycle performance.
• Establishes and maintains effective working relationships with governmental and commercial payers.
• Leads resolution of complex reimbursement issues, payer disputes, and contract operational implementation.
• Recruits, develops, mentors, and evaluates Revenue Cycle staff while fostering a culture of accountability, collaboration, and continuous improvement.
• Ensures appropriate staffing levels and manages departmental resources within approved budgets.
• Provides ongoing education and training regarding billing regulations, coding requirements, payer updates, and organizational policies.
• Partners with Clinical, Operations, Finance, Compliance, Information Technology, and Executive Leadership to improve Revenue Cycle performance and organizational outcomes.
• Provides regular Revenue Cycle performance reports and recommendations to senior leadership.
• Performs other duties as assigned by the Chief Financial Officer.

EDUCATION AND EXPERIENCE:

• Bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or related field required; Master's degree preferred.
• Minimum seven (7) years of progressively responsible healthcare Revenue Cycle experience.
• Minimum five (5) years of leadership experience managing Revenue Cycle teams.
• Experience in an FQHC or Community Health Center strongly preferred.
• Experience with Medicare, Medicaid, commercial insurance, and value-based reimbursement models.
• Experience with Sage Intacct, eClinicalWorks (eCW), clearinghouse applications, and Revenue Cycle reporting tools preferred.
• Professional certifications such as CRCR, CPC, CPB, or HFMA certification are preferred.
• Strong analytical and financial reporting skills.
• Demonstrated ability to analyze operational and financial data and develop actionable recommendations.
• Experience leading process improvement and organizational change initiatives.
• Knowledge of healthcare reimbursement methodologies including Medicare PPS, Medicaid PPS, managed care, and value-based payment models.
• Experience developing and monitoring departmental performance metrics.
• Strong project management skills.
• Ability to lead cross-functional teams and influence organizational change.

Why work at CCI?

• Extensive benefits plan including PTO
• 403B Retirement Plan
• Tuition reimbursement opportunities
• Continuing education assistance; can be used toward obtaining certifications, renewal of certifications, or possible conference attendance.
• Our providers are insured for malpractice under FTCA.

Equal Employment Opportunity (EEO)

CCI Health Services does not unlawfully discriminate based on race, religion, color, national origin, citizenship, ancestry, physical or mental disability, legally protected medical condition (cancer related or genetic characteristics or any genetic information), marital status, sex, sexual orientation, gender identity, gender expression, pregnancy, age (40 or older), military and/or veteran status or any other basis protected by federal or state law. All personnel decisions are to be administered in accordance with this policy and in compliance with applicable federal and state law, including, but not limited to, decisions regarding recruitment, selection, training, promotion, compensation, benefits, transfers, lay-offs, tuition assistance, and social and recreational programs.

The CEO & President of CCI and all managerial personnel are committed to this policy and its enforcement. Employees are directed to bring any violation of this policy to the immediate attention of their supervisor, Human Resources, or the CEO & President. Any employee who violates this policy or knowingly retaliates against an employee reporting or complaining of a violation of this policy, shall be subject to immediate corrective action, up to and including termination of employment. Complaints brought under this policy will be promptly investigated and handled with due regard for the privacy and respect of all involved.