Revenue Cycle Manager

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Description

This position oversees the entire revenue cycle-from claims processing and clearinghouse operations to A/R management, payer relations, compliance, and staff development. The Revenue Cycle Manager collaborates closely with clinical, operational, and administrative leadership to ensure timely and accurate billing, maximize reimbursement, and uphold high standards of compliance and service.

QUALIFICATIONS NEEDED FOR POSITION:

Experience Requirements:

• Minimum 5 years of medical billing or business office management, with at least 2-3 years in a supervisory or department leadership role.
• Experience with FQHC billing preferred, experience with Medicare/Medicaid, commercial payer rules, and compliance requirements.
• Proficiency in EMR billing systems, clearinghouse platforms, and Microsoft Office applications.

Skills Requirements:

• Strong analytical and problem-solving skills, including ability to interpret financial data and identify trends.
• Excellent communication, presentation, and organizational abilities.
• Demonstrated leadership, professionalism, integrity, and adaptability.
• Ability to establish priorities, coordinate work activities, and manage competing deadlines.

Education Requirements:

• Bachelor's degree in business, Healthcare Administration, Finance, or related field; or equivalent progressive experience in revenue-cycle leadership.

Requirements

Revenue Cycle Leadership & Strategy

1. Direct and manage all components of the revenue cycle, ensuring alignment with BRHC goals and FQHC requirements.

2. Develop, implement, and maintain billing and revenue cycle standard operating procedures (SOPs).

3. Monitor revenue performance, analyze trends, and provide monthly reports, metrics, and recommendations to leadership.

Billing Operations & Compliance

4. Oversee claims submission, clearinghouse workflows, and resolution of rejected/denied claims.

5. Ensure compliance with Medicare, Medicaid, and commercial payer billing requirements, with a strong focus on FQHC regulations.

6. Act as EMR billing super-user and co-administrator, partnering with the CAS for issue resolution and system optimization.

A/R and Performance Management

7. Manage A/R aging, identify underpayments, determine root causes, and implement corrective actions.

8. Conduct regular internal audits of coding and billing accuracy; provide coaching and education to staff.

9. Monitor open encounters and ensure timely completion to support accurate billing.

Team Leadership

10. Hire, train, supervise, and evaluate billing staff, fostering an environment of accountability, teamwork, and continuous improvement.

11. Provide ongoing staff education regarding billing best practices, regulatory updates, and workflow expectations.

Cross-Functional Collaboration

12. Work with clinical and administrative teams to streamline processes and improve revenue cycle outcomes.

13. Maintain strong relationships with payers, vendors, coding consultants, credentialing partners, and outside billing resources.

Additional Oversight Responsibilities

14. Oversee provider insurance credentialing processes managed through BRHC's contracted credentialing agency.

15. Supervise relationships and performance of outside payment posting vendors and contracted collection agencies.

NON-ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. May provide backup for other Health Center functions as needed.

2. Performs other duties as assigned.

GENERAL EXPECTATIONS:

1. Be committed to the mission and values of the Bucksport Regional Health Center.

2. Work as a member of the Finance team in the performance of duties.

3. Be punctual for scheduled work and use time appropriately.

4. Work in harmonious relationships with all staff, patients, vendors and others.

5. Perform duties in a conscientious, cooperative manner.

6. Perform the required amount of work in a timely fashion with a minimum of errors.

7. Be neat and maintain a professional appearance.

8. Maintain confidentiality in accordance with HIPAA and organizational policies.

9. Represent BRHC professionally in interactions with patients, staff, and community partners.

PHYSICAL REQUIREMENTS:

The physical requirements described here are representative of those that must be met by the Incumbent to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to stand; walk; sit; use hands to handle, or feel, including operation of a standard computer keyboard; reach with hands and arms and talk, see and hear; prolonged sitting required. Eye hand coordination and manual dexterity is required. The employee must occasionally lift/move up to 25 pounds, bend, stoop, stretch or crouch. Specific vision abilities required by the job include close vision, distance vision, and the ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those of the incumbent encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Work is performed primarily in an office setting. Noise levels are usually quiet.