Revenue Cycle Manager

ZUFALL HEALTH CENTER INC•Dover, NJ

6d•Onsite

About The Position

Reporting to the Chief Financial Officer, the Revenue Cycle Manager is responsible for the strategic oversight and day-to-day management of all revenue cycle operations for a Federally Qualified Health Center (FQHC) generating approximately $26 million in annual patient revenue. This role ensures optimal financial performance through effective management of billing, collections, reimbursement, front-end revenue processes, and compliance with federal, state, and payer regulations specific to FQHC Prospective Payment System (PPS) reimbursement. The Revenue Cycle Manager leads revenue integrity initiatives, drives performance improvement, strengthens internal controls, and ensures timely and accurate reimbursement from Medicaid, Medicare, managed care organizations, commercial payers, and self-pay patients.

Requirements

Strong analytical and financial acumen
Knowledge of PPS reimbursement methodology
Regulatory compliance expertise
Leadership and team development skills
Process improvement orientation
Advanced Excel and revenue analytics capability
Experience with eClinicalWorks
Bachelor’s degree in Healthcare Administration, Finance, Business, or related field required.
5+ years of healthcare revenue cycle experience.
Minimum 2–3 years in a supervisory or management role.
Strong understanding of Medicaid and Medicare FQHC billing rules.

Nice To Haves

Master’s degree preferred.
FQHC experience strongly preferred.
HFMA (CRCR or CHFP)
CPC or CPB
FQHC-specific revenue training

Responsibilities

Direct and oversee all components of the revenue cycle, including: Patient registration and eligibility verification
Sliding Fee Scale application and compliance
Charge capture and coding
Claims submission
Payment posting
Accounts receivable (A/R) management
Denials management and appeals
Patient collections
Ensure accurate FQHC PPS and wrap-around billing.
Monitor charge lag, claim lag, denial rates, and A/R days.
Develop and monitor KPIs, including: Days in A/R (target: less than 40 to 45 days, typical for FQHC) Net collection rate (greater than 95%)
Denial rate (less than 5 to 7%)
Clean claim rate (greater than 95%)
Prepare and present monthly revenue cycle performance reports to CFO and executive leadership.
Analyze payer mix and reimbursement trends.
Identify revenue leakage and implement corrective action plans.
Ensure compliance with: HRSA regulations
UDS reporting requirements
Medicaid and Medicare FQHC billing rules
Sliding Fee Discount Program (SFDP) regulations
340B-related billing considerations
Maintain knowledge of PPS rate changes, wrap payments, and cost report implications.
Collaborate with finance team during annual cost report preparation and audits.
Supervise billing, coding, A/R, and patient financial services staff.
Establish productivity benchmarks for billing and collections teams.
Conduct regular staff training on coding updates, payer rules, and compliance.
Foster a culture of accountability, customer service, and continuous improvement.
Participate in hiring, performance evaluations, and corrective action processes.
Implement structured denial management workflows.
Conduct root cause analysis of recurring denials.
Oversee timely appeals submission.
Ensure aged A/R follow-up protocols are consistently executed.
Manage high-dollar account resolution.
Partner with IT and EHR vendors to optimize billing workflows.
Improve automation in claims scrubbing and eligibility verification.
Develop internal controls to minimize billing errors.
Lead revenue cycle improvement initiatives.
Participate in implementation of new payer contracts or service lines.
Work closely with: Clinical leadership to improve documentation accuracy
Front desk staff to strengthen front-end collections
Finance department for reconciliation and reporting
Educate providers on documentation requirements that impact reimbursement.
Direct supervision of billing and revenue cycle staff (typically 5–12 FTEs depending on size).
Indirect oversight of front-end revenue processes.