The Revenue Cycle Director (RCD) is a full-time position responsible for overseeing coding, billing, and reimbursement related activities for the organization. This includes but is not limited to day-to-day revenue cycle team decisions, mastery of FQHC billing and coding all clinical services/procedure/diagnostics, compliance with federal, state, and commercial payer statutes/regulations, and end-to-end revenue cycle process optimization (e.g., charge capture to EDI to payment posting to unpaid claims/AR management). This position is responsible for following state and federal regulatory guidelines pertaining to third-party payments while maximizing cash flow and enhancing patient and clinical team experiences as well as customer relations.  

Primary Responsibilities/Essential Job Functions:

• Oversee the strategic & operational direction of the revenue cycle department, encompassing medical coding, charge capture, paper and electronic claim submissions, payment posting, accounts receivable follow-up, and reimbursement management.
• Directly supervise staff including providing performance coaching and feedback, and supervising workloads and schedules.
• Serve as the organizational subject matter expert for all coding, billing, and reimbursement related issues.
• Affirm compliant clinical and claim submission documentation as well as optimal coding, billing, and process management workload assuring accurate billing and efficient account collection.
• Analyze reimbursement data for accuracy and completeness.
• Optimize internal and external resources to compliantly, efficiently (i.e., in a timely manner), and thoroughly (e.g., all requisite claim data) submit claims to payers via electronic (e.g., clearinghouse) and/or paper formats as required by each payer and follow up on any related issues.
• Maintain positive and productive interdepartmental relations to obtain and analyze clinical information necessary for optimizing financial position and compliance.
• Create mutually beneficial performance objectives to optimize relationships between the revenue cycle and clinical teams including providers, managers, ancillary clinical staff, and front desk team members.
• Create and sustain a training program for clinical staff affording real-time feedback for documentation miscues.
• Audit and optimize existing procedures improve efficiency of revenue cycle operations.
• Assure revenue cycle operations are conducted in a legal, compliant, and ethical manner consistent with documented revenue cycle protocol adhering to federal, state, and other payer regulations, guidelines, and requirements.
• Participate in the development and implementation of Revenue Cycle Management related operating policies and procedures.
• Review and interpret revenue cycle operational data to assess the need for procedural revisions and enhancements.
• Participate in the design and implementation of specific systems to enhance revenue cycle and operating efficiency.
• With approval of CFO, analyze trends impacting the revenue cycle and cash flow and initiate appropriate action to realign staff, revise policies, and improve procedures related to revenue cycle.
• Keep up to date with all payer rule changes and distribute relevant information within the organization.
• Maintain mastery of necessary coding, billing, and reimbursement regulations and compliance requirements.
• Strategically lead and supervise Billing Manager to optimize revenue-cycle personnel, including but not limited to work allocation, PTO/staff scheduling, training, and optimal resource allocation.
• Motivate and engage team members and colleagues to achieve peak productivity and performance.
• Provide, oversee, and/or coordinate provision of training for new and existing revenue cycle team members regarding applicable operating policies, protocols, systems, procedures, standards, and techniques.
• Produce and present detailed revenue cycle activity reports and create team key performance indicators (KPIs).
• Depending on location, hybrid work schedule to be considered.

Job Expectations:

• Maintain open lines of communication with downline and CFO/VP of Finance.
• Address problems positively and engage non-defensively.
• Represent TCC in a professional and positive manner when dealing with clients, the public, volunteers, interns/externs, donors, and other staff, demonstrating a commitment to quality healthcare and excellent customer service.
• Participate with team members and leaders in identifying and improving systems, activities, behaviors, resolving issues, etc. which result in improving quality services.
• Maintain confidentiality according to HIPAA and to TCC policy.
• Attend and participate in all required meetings and training sessions.
• Participate in annual team review process.
• Understand individual and team responsibility.
• Assure team productivity levels are maintained.
• Demonstrate respect for diversity in daily activities.
• Meet TCC standards for performance measures and attendance/punctuality.
• Possess and maintain the highest integrity.
• Be diplomatic, analytical, and possess sound judgment.
• Interface with intermediaries
• Perform other duties as required or requested.

Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of all activities, duties or responsibilities that are required. Duties, responsibilities, and activities may change at any time with or without notice.

Qualifications:

• BA/BS degree (preferably in business or healthcare administration) or related field. Advanced degree preferred.
• Minimum of eight (8) years of healthcare revenue cycle experience.
• Medical coding certification preferred.
• FQHC coding, billing, and reimbursement experience desired. Medi-Cal claim experience strongly preferred.
• Minimum of five (5) years medical insurance/healthcare billing and collections experience in a medical practice or health system, with a deep understanding of medical billing rules and regulations.
• Family planning experience preferred.
• Five (5) years supervisory or management experience.
• Possess a strong working knowledge of HCPCS (e.g., CPT) and ICD-10 coding.
• Experience with Electronic Health Record systems and Clearinghouse billing.
• Epic experience preferred.
• Excellent oral and written communication skills; bilingual in Spanish preferred.

Competencies & Essential Skills:

Business Acumen: Ability to develop the keenness and quickness in understanding and dealing with situations in a manner that is likely to lead to a good outcome.

Communication/Interpersonal Skills: Must exhibit exceptional communication and interpersonal skills and ability to respond to difficult situations and to speak with staff at various levels in the organization.

Compliance/Ethical Practice: Demonstrate a commitment to the TCC mission and philosophy. Adhere to TCC’s policies and is committed to act legally and ethically within the scope of work.

Critical Evaluation: Ability to solve and analyze problems effectively and efficiently.

Cultural Awareness: Demonstrates ability to work effectively with individuals from diverse communities and cultures. Shows leadership and conflict resolution skills among people from a variety of cultures and backgrounds.

Organization: Excellent organizational skills and ability to multi-task.

Technology/Tools: Excellent computer skills in a Microsoft Windows environment. Must include knowledge of Excel and skills in Accounting and Human Resources Information Systems (HRIS).

Time Management: Ability to multi-task and work efficiently within close time constraints. Ability to work under pressure and in a highly stressful environment.