Senior Director of Revenue Cycle

PCC Community Wellness Center•Oak Park, IL

4d•$94,000 - $125,000•Onsite

About The Position

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.

Requirements

Bachelor's Degree in Healthcare Administration, Finance, Accounting, Business Administration, or related field required.
Minimum of 7 years of progressive healthcare revenue cycle leadership experience.
Minimum of 5 years managing multiple revenue cycle functions and teams.
Experience within a Federally Qualified Health Center (FQHC), Community Health Center, or similar healthcare environment strongly preferred.
Demonstrated experience managing in-house medical billing operations.
Proven success improving revenue cycle performance, reimbursement, and operational efficiencies.
Experience with Medicare, Medicaid, Managed Care, PPS reimbursement methodologies, and value-based reimbursement models.
Extensive knowledge of FQHC billing regulations and reimbursement methodologies.
Strong understanding of revenue cycle best practices and healthcare financial operations.
Experience negotiating and managing payer contracts.
Advanced analytical and financial management skills.
Strong leadership, communication, and relationship-building abilities.
Ability to effectively lead change and drive organizational improvement.
Advanced proficiency with Athenahealth Practice Management and Revenue Cycle Management systems required.
Experience utilizing Athenahealth reporting tools, work queues, dashboards, and revenue cycle analytics.
Advanced proficiency in Microsoft Office Suite, particularly Excel.

Nice To Haves

Master's Degree preferred.
Experience with healthcare financial reporting and business intelligence tools preferred.

Responsibilities

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.
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.
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.
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.
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.
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.
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.
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.
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.
Utilize data analytics to identify trends, opportunities, and operational improvements.
Present findings and recommendations to executive leadership.
Partner with Clinical Operations, Finance, Information Technology, Quality Improvement, and Credentialing teams to improve revenue cycle performance.
Participate in organizational strategic planning initiatives and operational improvement projects.
Support growth initiatives, service expansions, and payer strategy development.