Revenue Cycle Manager

Company Overview

Contentnea Health is a Community Health Center providing comprehensive medical, dental and behavioral health services for members of our communities in Greene, Pitt and Pamlico counties in eastern North Carolina.

Job Summary

Performs professional management and analytical functions to lead and coordinate all aspects of the revenue cycle, ensuring accurate billing, efficient collections, and maximized reimbursement.

Responsibilities and Duties

1. Oversees billing and collections operations to ensure timely, accurate claim processing, denial resolution, and compliance with payer requirements.

1. 1. Establishes and communicates production standards and goals; directs internal staff and external vendors to meet performance targets and maintains timely claim submission and denial resolution.
   2. Coordinates and manages clearinghouse and payer portal access, ensuring appropriate user rights and quarterly review of institutional and provider data for accuracy.
   3. Conducts regular meetings with internal and external billing teams to address issues, monitor performance, and support effective revenue cycle communication.
   4. Manages enrollment and credentialing staff to ensure maintenance of accurate provider data in payer systems to prevent billing disruptions.

1. Supervises the patient financial counseling team, directing daily activities and assisting with processes to ensure appropriate communication of patient financial responsibilities, accurate application of assistance programs, and compliance with financial policies.

1. 1. Supervises financial counselors to ensure timely communication of patient financial responsibilities, working collaboratively with billing staff, practice managers, and front desk staff to support patient understanding prior to scheduled appointments.
   2. Ensures consistent and accurate application of the Sliding Fee Discount Program (SFDP), including quarterly audits and performance reporting for policy compliance.
   3. Monitors and directs financial counseling staff in carrying out collection activities, including establishing and maintaining payment plans, following up on outstanding balances, and securing patient payments in alignment with organizational policy.
   4. Directs financial counselors in assisting patients with enrollment in available assistance programs (e.g., ACA, Medicaid eligibility, Fee Waiver and Reduction Policy, or other external support programs) to promote patient access to care.

1. Manages revenue cycle management (RCM) activities to ensure all financial transactions, claims, and collections are accurate, timely, and compliant with payer and regulatory requirements.

1. 1. Maintains organized documentation for RCM functions, including remittance advices, payer correspondence, fee schedules, and related records.
   2. Monitors claim submission, rejection, and denial trends to ensure timely filing and resolution in accordance with organizational benchmarks.
   3. Ensures reconciliation of payments and adjustments in patient accounts, resolution of credit balances, and processing of refunds per policy.
   4. Reviews small balance write-offs, ensures write-offs are completed in accordance with policy, and prepares and submits the quarterly Medicare credit balance report to the Chief Financial Officer for approval within required deadlines.
   5. Collaborates with practice Managers and the Chief Operating Officer to maximize self-pay collections, resolve patient billing concerns, and ensure monthly processing of patient statements.
   6. Develops, updates, and implements written departmental procedures, and works cross-functionally to improve verification and pre-authorization processes that support collection goals.

1. Serves as a subject matter expert and operational lead for billing, coding, Federally Qualified Health Center (FQHC) standards, value-based payment arrangements and revenue cycle system configurations.  

1. 1. Manages and maintains billing configurations within the electronic health record (EHR), clearinghouse, and related revenue cycle applications; collaborates with internal IT and vendor support teams to ensure accurate setup, maintenance, and functionality of payer mappings, claim rules, and fee schedules.
   2. Participates in billing and payer trainings, payer workgroups, and professional FQHC forums; represents the organization in meetings with payers, clinically integrated networks, and Accountable Care Organizations to remain current on regulatory requirements, reimbursement models, and best practices.
   3. Monitors coding accuracy and collaborates with quality improvement staff to strengthen documentation, optimize encounter-level coding, and maximize performance in value-based and incentive programs.
   4. Communicates payer, program, SFDP, coding, and billing updates in writing to internal staff and external billing vendors, ensuring timely implementation of operational and configuration changes across systems.
   5. Reviews revenue cycle performance summaries and key performance indicators (KPIs) and supports the implementation of recommended process improvements and revenue optimization strategies.

1. Leads Revenue Cycle Data Analysis and Performance Optimization.

1. 1. Performs detailed, ongoing analysis of revenue cycle performance data to identify trends, variances, root causes, and areas of poor performance across billing and collections activities by payer, service line, provider, or location.
   2. Uses revenue cycle analytics to target underperforming payers, workflows, and processes and develops corrective strategies to improve claim outcomes, reduce denials, accelerate resolution, and strengthen collection performance.
   3. Evaluates and modifies electronic health record (EHR) and revenue cycle system configurations, workflows, and claim edit rules as needed to correct billing and collections issues and enhance operational efficiency and accuracy.
   4. Develops and presents comprehensive revenue cycle reports, dashboards, and data-driven recommendations to senior leadership, including the Chief Financial Officer and Chief Operating Officer, to support decision-making, strategic planning, and revenue optimization initiatives.

1. Provides management to departmental staff.

1. 1. Contributes to development of the budget; maintains and monitors the departmental budget.
   2. Determines the most effective method for assigning responsibilities and duties to department employees.
   3. Maintains job descriptions, procedures and other documentation related to the organization of the department.
   4. Assigns duties and responsibilities, and ensures employees receive instruction/training needed to complete their job responsibilities.
   5. Ensures that employees are aware of and adhere to all company policies and procedures, and conveys all senior management communications and directives.
   6. Reviews departmental work for thoroughness and accuracy, and provides specific instructions on completion of tasks/responsibilities.
   7. Prepares and conducts performance appraisals for immediate staff.
   8. Conducts hiring, disciplinary, and termination procedures.

Bachelor's Degree in Business Administration or Informatics. 
Current knowledge of third-party payers, special programs, Sliding Fee Discount Program, and Chapter 9 and 16 of the Health Center Compliance Manual.
Maintains current knowledge of FQHC payment methodologies and general billing rules through participation in continuing education.
Possesses an extensive and detailed knowledge of medical terminology, procedural and diagnostic coding, medical-dental cross-coding, electronic claims processing and of insurance policies and contracts for multiple insurance vendors.
Possesses advanced knowledge and proficiency in revenue cycle data analysis, including interpretation of key performance indicators (KPIs), trend analysis, root cause identification, and development of data-driven recommendations to improve billing and collections performance.
Able to evaluate, modify and optimize EHR and revenue cycle system configurations based on analytical findings and operational performance data.
Exhibits expertise in developing and delivering detailed revenue cycle reports, dashboards, and performance analyses used to support leadership decision-making, strategic planning, and revenue optimization initiatives.
Strong technical proficiency with revenue cycle reporting tools, data visualization platforms, and advanced Excel or business intelligence applications.
Experience in an FQHC and with eClinicalWorks highly preferred.