Revenue Cycle Manager

The Revenue Cycle Manager is responsible for managing the revenue cycle for all Hurtt Family Health Clinic services. The primary duties will include training and supervision of billing staff, oversight of all billing related processes, monthly reporting, and maintenance of the schedule of charges. The position will report to the Chief Operating Officer, while working closely with the Chief Financial Officer and the finance department, as well as all levels of management and provider staff.

This is a full time position located on-site in Tustin, CA.

The best candidate for this position: 

• has experience in a Federally Qualified Health Center (FQHC) or community health setting
• has at least 5 years of experience in medical billing/revenue cycle management, with 2+ years in a supervisory or leadership role
• has a Professional Coder Certification (preferred) 
• is knowledgeable of Medicaid, Medicare, commercial insurance billing, and federal grant funding expectations
• is proficient in analyzing revenue cycle metrics and driving process improvements

What You'll Do: 

Job Responsibilities & Duties

• Develop, implement and oversee effective billing and collections procedures encompassing all service lines (medical, dental, behavioral health, chiropractic, acupuncture, optometry and enhanced care management)
• Train and supervise appropriate billing staff to assist with the revenue cycle functions
• Ensure the organization maximizes billing by providing ongoing training and support to Patient Services Representatives (PSRs)
• Partner with managers and leadership to establish, implement, and refine front office protocols that support efficient revenue cycle operations
• Manage the configuration of all electronic billing systems to ensure proper functioning for effective and efficient billing and collection processes.
• Maintain fee schedule for each service area.
• Develop, implement and oversee procedures to ensure coding accuracy.
• Ensure sliding fees are followed and calculated, posted and adjudicated correctly
• Establishes and maintains effective working relationships with external vendors, service providers, and internal finance staff to ensure accurate billing, timely claims processing, and efficient financial operations.
• Serves as the primary liaison to resolve billing discrepancies, coordinate contract terms, and implement process improvements in partnership with the finance department.
• Ensure timely monthly close of the billing function.
• Prepare and distribute end of month management reports.
• Provide support and training to practitioners to ensure accurate, timely filing of claims
• Ensure the timely submission of all claims for payment to third party payers.
• Develop, implement and oversee procedures for the review, appeal and resubmission of all claim denials.
• Manage the reconciliation of all discrepancies found in billing records in a timely manner, and provide reports to management or outside entities, as appropriate
• Develop, implement and oversee procedures for the posting of all third party payments received and the reconciliation of identified differences
• Analyze claims data and suggest/implement procedures to maximize HEDIS and incentive revenue collections (i.e., level II HCPCS codes, ICD-10 and CPT modifiers)
• Provide oversight and management of billing staff work assignments
• Conduct quality assurance and accuracy audits of patient accounts
• Compile requested statistical, financial, billing or auditing reports
• Responsible for timely refund of account overpayments.
• Upholds all HIPAA requirements in a manner consistent with HFHC policies, standards of conduct, state and federal laws and regulations
• Reviews contracts to ensure contract fees are entered correctly, and routinely audits receipts to ensure payor compliance with contract terms
• Handle routine correspondence and other administrative tasks, as required.
• Perform other duties as assigned.

 What You'll Bring: 

Minimum Qualifications

• Associate’s degree in business administration, Health Care Administration, Finance or Accounting or related field preferred
• At least 5 years of experience in medical billing/revenue cycle management, with 2+ years in a supervisory or leadership role.
• Experience in a Federally Qualified Health Center (FQHC) or community health setting strongly preferred.
• Professional Coder Certification, preferred.
• Knowledge of Medicaid, Medicare, commercial insurance billing, and federal grant funding expectations.
• Proficient in analyzing revenue cycle metrics and driving process improvements.