Senior Director of Revenue Cycle

## Description

**Position Summary**

The Senior Director of Revenue Cycle is responsible for the strategic leadership, direction, and oversight of all revenue cycle operations for PCC Community Wellness Center. This position oversees the full continuum of the revenue cycle, including patient access, eligibility verification, provider enrollment, charge capture, coding, billing, claims management, denial prevention, payment posting, collections, accounts receivable management, managed care contracting, and reimbursement optimization.

As a Federally Qualified Health Center (FQHC), PCC relies heavily on maximizing reimbursement through Medicare, Medicaid, Managed Care Organizations, and commercial payers. The Senior Director of Revenue Cycle serves as a key organizational leader responsible for ensuring financial sustainability, regulatory compliance, operational excellence, and continuous process improvement across all revenue cycle functions.

The Senior Director partners closely with Finance, Clinical Operations, Credentialing, Information Technology, Quality Improvement, and Executive Leadership to develop and execute strategies that enhance revenue performance, improve operational efficiency, and support PCC's mission of delivering high-quality healthcare services to the communities we serve.

**Essential Duties and Responsibilities**

Revenue Cycle Leadership

• Provide strategic oversight and leadership of all revenue cycle operations from patient registration through final reimbursement.
• Develop and execute revenue cycle initiatives that improve reimbursement, cash flow, operational efficiency, and patient experience.
• Establish departmental goals, performance metrics, and accountability standards.
• Lead, mentor, and develop a high-performing revenue cycle team while fostering a culture of collaboration, accountability, innovation, and continuous improvement.
• Provide regular reporting and analysis to executive leadership regarding revenue cycle performance and financial outcomes.

FQHC Billing and Reimbursement Management

• Ensure compliance with all FQHC billing regulations and reimbursement methodologies.
• Oversee billing operations for:
• Medicare Prospective Payment System (PPS)
• Medicaid Prospective Payment System (PPS)
• Managed Medicaid Plans
• Medicare Advantage Plans
• Commercial Insurance
• Self-Pay Accounts
• Sliding Fee Discount Program
• Monitor reimbursement trends and implement strategies to maximize revenue capture.
• Ensure accurate encounter billing and compliance with federal and state regulations governing FQHC reimbursement.

In-House Billing Operations

• Direct all internal billing and collections functions, ensuring timely and accurate claim submission and payment resolution.
• Monitor claim processing workflows and identify opportunities to reduce billing errors and improve reimbursement outcomes.
• Oversee accounts receivable management and establish performance targets related to collections and aging.
• Develop and implement strategies to reduce outstanding receivables and improve cash collections.

Athena Health Revenue Cycle Management

• Serve as the executive operational lead for Athenahealth Practice Management and Revenue Cycle Management workflows.
• Collaborate with operational and clinical leaders to optimize Athenahealth functionality, charge capture, claim edits, work queues, reporting, and automation tools.
• Utilize Athenahealth reporting and analytics to identify trends, revenue opportunities, denial patterns, and workflow inefficiencies.
• Lead system optimization initiatives to improve operational performance and financial outcomes.

Revenue Integrity and Denial Management

• Develop and implement comprehensive denial prevention and resolution strategies.
• Analyze denial trends and establish corrective action plans.
• Monitor revenue leakage and identify opportunities to improve charge capture and reimbursement accuracy.
• Ensure proper coding, documentation, and billing practices to maximize revenue integrity.

Managed Care Contracting

• Lead negotiations with Managed Care Organizations and commercial payers.
• Analyze payer contracts, reimbursement methodologies, and financial performance.
• Develop recommendations to improve reimbursement rates and contract terms.
• Monitor contract compliance and payer performance.

Provider Enrollment and Credentialing Support

• Collaborate with Credentialing and Provider Operations to ensure timely enrollment, credentialing, revalidation, and payer participation.
• Monitor enrollment status and mitigate revenue risk associated with enrollment delays.
• Develop processes to ensure providers are appropriately credentialed and billable upon hire.

Compliance and Regulatory Oversight

• Ensure compliance with:
• HRSA requirements
• Medicare regulations
• Medicaid regulations
• HIPAA regulations
• OIG guidance
• FQHC billing requirements
• State and federal healthcare regulations
• Maintain audit readiness and oversee payer audits, reviews, and corrective action plans.
• Develop and maintain internal controls to mitigate financial and compliance risks.

Data Analytics and Financial Performance

• Monitor and report key performance indicators including:
• Days in Accounts Receivable
• Net Collection Rate
• Clean Claim Rate
• Denial Rate
• First Pass Resolution Rate
• Visit-to-Bill Lag
• Reimbursement by Payer
• Sliding Fee Utilization