Revenue Cycle Manager

This is a hybrid position requiring 1–2 days per week in the office. Schedule is Monday through Friday 8:00am-4:30pm

POSITION SUMMARY

The Revenue Cycle Manager is a key leadership role within the Finance department, responsible for the full lifecycle of revenue operations at Fora Health. This position oversees the Billing/Authorization team, ensuring that claims are accurately coded, submitted, and collected in a timely manner, and that all contracts and grants are properly administered, invoiced, and reported. 

Reporting to the Director of Finance and Accounting, the Revenue Cycle Manager serves as the organization's subject matter expert on payer regulations, billing compliance, and revenue optimization. This role is responsible for translating complex Oregon Health Plan, Medicaid, and commercial payer requirements into efficient operational workflows. This role plays a critical part in sustaining Fora Health's financial health so that the organization can continue delivering accessible, high-quality substance use disorder treatment to the communities it serves. 

The Revenue Cycle Manager leads a team of billing professionals, fostering a culture of accuracy, accountability, and continuous learning. This position partners closely with clinical and operational leadership to resolve billing issues, reduce denials, and identify opportunities to maximize reimbursement while ensuring all practices remain fully compliant with Federal, State, and payer-specific requirements. 

ESSENTIAL JOB DUTIES: The Revenue Cycle Manager will have multiple areas of focus including

Billing and Revenue Collection: 

• Serve as the go-to expert for all coding and billing processes, guiding your team to achieve peak performance. 
• Oversee the entire billing cycle, from patient insurance to collections, ensuring accuracy and efficiency at every step. 
• Research and translate complex and ambiguous state-level and payor-specific rules into actionable system logic. 
• Stay ahead of industry changes, ensuring our operations align with Federal, State, and payer regulations. 
• Monitor and analyze billing trends, adjust staff and procedures to maximize efficiency and revenue. 
• Perform root-cause analysis to identify denials patters and work to resolve payor or internal issues. 
• Audit current procedures and implement new strategies to enhance the efficiency of our billing and collections operations. 

Leadership:

• Supervise, train, and motivate your team, fostering a culture of excellence and continuous growth. 
• Collaborate effectively with clinical staff and other departments to streamline coding procedures, resolve any issues promptly, facilitate smooth billing processes. 
• Create and monitor Key Performance Indicators (e.g., net collection rate, days in AR, clean claim rate, denial rates, etc.).

Contracting:

• Manage and track payor contracts to ensure up to date compliance of Fora billing practices and work with internal leadership and payors as needed to negotiate rates. 
• Update EHR and billing with rate changes ensuring accurate reporting of anticipated revenue. 

Credentialling:

• Oversee staff credentialling ensuring up-to-date State and payor credentials. 
• Work with HR and hiring managers to on-board new staff to efficiently and effectively credential new providers.   

ADDITIONAL JOB RESPONSIBILITIES

• Attend staff meetings as scheduled.
• Additional trainings to be completed as assigned in a timely manner.
• Special projects and other duties as assigned.
• Participate in ongoing supervision and consultation.
• Provide leadership to the teams in such a way that the work environment supports and encourages values of the agency: honesty, empathy, respect, inclusion, unity.

SUPERVISORY FUNCTIONS

This position has supervisory duties.

Revenue Cycle Manager will directly oversee the Billing Supervisor and Claim Specialist as well as support their staff as needed. 

QUALIFICATIONS

EDUCATION AND EXPERIENCE REQUIRED

Bachelor’s degree and/or five years commensurate experience with a minimum of two years of supervisor/manager experience within the revenue cycle function in the behavioral health industry.  

KNOWLEDGE, SKILLS AND ABILITIES REQUIRED

• Experience with Oregon Health Plan (OHP)/Medicaid and Medicare billing 
• Experience with behavioral health billing codes 
• Experience with an EHR (e.g., Credible, Netsmart, Epic, eClinicalWorks, etc.) 
• Clearinghouse experience (Waystar, Availity, etc.) 
• Familiarity with payor portals 
• Ability to interpret and apply state-specific payor guidelines and regulations 
• Ability to lead collaborations in a cross-team environment 
• Ability to recognize patterns  
• Comfortable creating solutions when ambiguity exists  
• Professional demeanor, excellent communication, and interpersonal skills 
• Initiative and problem-solving skills including creativity, resourcefulness and timeliness  
• Ability to organize time, set priorities and meet deadlines of conflicting demands 
• Strong capability of working both independently and as a member of a collaborative team 
• Excellent written and verbal communication skills.  
• Knowledge of areas related to agency licensing and operations 
• Demonstrates flexibility regarding job duties and assignments 
• Proficient in Microsoft Office Suite, specifically Outlook, Excel and Word
• Ability to maintain professional boundaries with patients, the community, and other staff members.
• Displays initiative and problem-solving skills
• Basic knowledge of substance-use disorders
• Marked ability to demonstrate and utilize self-awareness

OTHER REQUIREMENTS

• For employees with a history of substance use disorder, Fora Health’s policy requires certification of a minimum of six months of sobriety for this position.
• Ability to pass a pre-employment or for cause drug tests.
• Ability to pass DHS criminal background
• Position will require some amount of regular connection to work via cell phone to answer questions and respond to internal and external contacts.

WORKING CONDITIONS

• This position generally works in an indoor office environment with infrequent travel between sites or to special events. 
• Prolonged use of computer.
• Position will require some amount of regular connection to work via cell phone to answer questions and respond to internal and external contacts.
• Possible exposure to upset, angry, severely traumatized, disabled or emotionally disturbed adults, adolescents, and families.
• Exposure to potentially hazardous cleaning chemicals, personal protective equipment provided.