Director of Revenue Cycle

APLA Health • Los Angeles, CA

114d • $128,263 - $173,895

About The Position

Under the direction of the Chief Financial Officer, the Director of Revenue Cycle manages front-end patient registration, coding, billing, and collections to maximize reimbursement and ensure compliance, particularly with Medicaid and Medicare Prospective Payment Systems (PPS). Key responsibilities include overseeing claims processing, minimizing denials, managing payer contracts and relationships, ensuring regulatory compliance, and providing strategic leadership for the entire revenue cycle. The role requires strong leadership, analytical skills, and expertise in FQHC-specific (Federally Qualified Health Center) billing and coding requirements. This position supervises the Revenue Cycle Manager and the Enrollment and Eligibility Manager.

Requirements

• Bachelor’s Degree in a Healthcare, Quality Assurance, or related field required.
• A minimum of 10 years of relevant experience, with no less than 7 years in an FQHC.
• Minimum of 5 years’ experience managing staff.
• Experience with the provider credentialing process preferred.
• Experience with dental billing is highly preferred.
• Proficiency with healthcare billing software and revenue cycle management tools required.
• Proficiency in Microsoft Excel.
• Knowledge of Medicare, Medicaid, HMO, PPO, Managed Care, Workers Comp, and Tricare.
• FQHC revenue cycle and billing requirements.
• Professional fee billing, reimbursement and third-party payer regulation and medical terminology.
• Regulatory requirements pertaining to health care operations and their impact on operations.
• Healthcare regulations (e.g., HIPAA, CMS guidelines).

Responsibilities

• Provide overall direction for APLA Health’s revenue cycle operations.
• Develop, implement and oversee effective billing and collections procedures.
• Oversee all aspects of patient enrollment, insurance verification, coding, billing, claims processing, and payment posting.
• Ensure adherence to all FQHC-specific federal, state, and payer regulations, including HRSA guidelines.
• Ensure sliding fees are followed and calculated annually (posted and internal EHR system).
• Manage the configuration of all electronic billing systems to ensure proper functioning for effective and efficient billing and collection processes.
• Maintain fee schedules.
• Develop, implement and oversee procedures to ensure coding accuracy.
• Ensure timely monthly close.
• Prepare and distribute end-of-the-month management reports.
• Provide support and training to practitioners to ensure accurate and timely filing of claims.
• Analyze claims data and implement procedures to maximize HEDIS and incentive revenue collections (i.e., level II HCPCS codes, ICD-10 and CPT modifiers).
• Track and report metrics related to the patient engagement cycle including recording coding error rates and billing turnaround times to develop sound revenue cycle analysis and reporting.
• Maintain and manage all applicable registrations and periodic reporting for CMS (Medicare and Medicaid).
• Assist in preparing, validating and submitting Revenue Cycle information for the Medicare Cost Reports.
• Work closely with the Chief Medical Officer, Chief Nursing Officer, Chief Clinical Operations Officer, Chief Dental Officer, and Chief Behavioral Health Officer to coordinate patient billing and payment requirements.
• Balance and reconcile bank deposits for Patient Accounts Receivable.
• Work with the CFO to develop processes and procedures for the efficient and successful flow of information between the billing department and clinical departments.
• Execute upon key strategies and performance indicators to drive the collection of earned reimbursement.
• Implement and maintain policies and procedures to ensure the proper investigation and resolution of denied or rejected claims.
• Oversee the submission and reconciliation of Medicare and Medicaid claims and PPS cost reports to secure accurate reimbursement.
• Implement strategies to reduce claim denials and manage the appeals process to recover lost revenue.
• Manage relationships with third-party billing vendors and negotiate and manage contracts with insurance payers.
• Track and report on key performance indicators (KPIs) such as days in accounts receivable, denial rates, and clean claim rates to drive improvements.
• Lead, mentor, and train revenue cycle staff and enrollment staff to ensure efficient and compliant operations.
• Drive continuous improvement initiatives to optimize workflows, systems, and financial performance.

Benefits

• Equal Opportunity Employer: minority/female/transgender/disability/veteran.

What This Job Offers

• Job Type: Full-time
• Education Level: Bachelor's degree
• Number of Employees: 101-250 employees