Director of Revenue Cycle

Elevated-Community-Health; Frisco (CO); Presencial; USD 90 000 - 120 000; Tempo integral

Resumo da oferta

Elevated Community Health in Frisco, CO seeks a Director of Revenue Cycle to provide strategic leadership and oversee all revenue cycle activities across medical, dental, behavioral health, pharmacy, and enabling services.

The role leads enrollment, credentialing, patient access, billing, coding, AR, and analytics, collaborating with HRSA and payer requirements to optimize reimbursement and patient financial experience.

Qualificações

• Bachelor's degree is required.
• 7 years' experience in revenue cycle management.
• 5 years of supervisory experience required.

Responsabilidades

• Lead Revenue Cycle operations and staff development.
• Oversee patient registration, eligibility verification, and credentialing.
• Ensure compliant billing, coding, accounts receivable, and denial management.

Formação académica

Bachelor's degree or equivalent

7 years revenue cycle experience

5 years supervisory experience

Ferramentas

Power BI

OCHIN EPIC

Descrição da oferta de emprego

• Location 360 Peak One Dr,Frisco, CO, 80443,United States
• Base Pay $90,000.00 - $120,000.00 / Year
• Employee Type FT Exempt
• Required Degree 4 Year Degree
• Manage Others Yes

Position Summary:
The Director of Revenue Cycle provides strategic leadership and operational oversight of all revenue cycle activities for Elevated Community Health (ECH). This position ensures optimized reimbursement, cash flow, regulatory compliance, and the patient financial experience across medical, dental, behavioral health, pharmacy, and enabling services.

The Director will lead all aspects of revenue cycle performance, including patient registration, eligibility verification, sliding fee discount program administration, charge capture, coding, billing, accounts receivable, denial management, payment posting, provider credentialing, payer enrollment, revenue cycle analytics, and revenue-related technology systems.

The Director directly supervises the Eligibility Manager and Patient Access Manager. They collaborate closely with clinical, operational, compliance, information technology, and finance leadership to achieve organizational financial goals while maintaining compliance with HRSA, Medicare, Medicaid, and commercial payer requirements.

The Director will support ECH's Access, Stewardship, and Quality (ASQ) priorities by improving access to care through efficient revenue cycle processes that reduce barriers to services, promoting stewardship through effective revenue cycle operations and financial performance, and enhancing quality through accurate, compliant revenue cycle practices and positive patient financial experience.

Essential Functions:
Revenue Cycle Leadership

• Establish organizational goals, KPIs, policies/procedures, and performance improvement initiatives relative to all Revenue Cycle operations.
• Lead revenue cycle staff development, succession planning, and performance management.
• Monitor and improve financial performance through revenue cycle optimization.
• Collaborate with executive leadership to support organizational growth initiatives.
• Evaluate revenue cycle vendor performance and contracts.
• Participate in financial forecasting and revenue planning.
• Oversee provider enrollment and credentialing with Medicare, Medicaid, managed care organizations, and commercial payers.
• Monitor revalidation and recredentialing activities.
• Ensure timely enrollment of new providers and locations.
• Minimize reimbursement delays related to credentialing deficiencies.
• Provide leadership to the following enrollment and eligibility functions:
  • Medicaid/CHP+ enrollment
  • Sliding fee discount enrollment & determinations
  • ECH Patient Assistance Fund
• Ensure an exceptional patient financial experience.
• Develop policies supporting financial access and affordability for patients.
• Monitor self-pay collections and financial assistance processes.
• Provide leadership to the following patient registration functions:
  • Patient Registration
  • Insurance verification
  • Prior authorizations
  • Point-of-service collections
• Develop and monitor patient registration performance standards related to registration accuracy, eligibility verification, and point-of-service collections.
• Ensure accurate and timely collection of demographic, insurance, and financial information to support reimbursement, regulatory compliance, and quality reporting.
• Partner with operational and clinical leaders to improve patient registration processes, reduce registration-related claim denials, and enhance the overall patient experience.

Revenue Integrity & Charge Capture

• Implement controls to ensure complete and accurate charge capture.
• Partner with providers and operational leaders to improve documentation quality.
• Monitor encounter closure timeliness and documentation deficiencies.
• Oversee provider coding education, audits, and compliance monitoring.
• Analyze missed revenue opportunities and implement corrective measures.
• Ensure proper use of CPT, HCPCS, ICD-10-CM, CDT, and applicable coding guidelines.

Billing, Coding & Collections

• Oversee all billing operations for medical, dental, and behavioral health services.
• Ensure compliance with federal, state, payer, and regulatory billing requirements.
• Ensure timely and accurate claim submission and payment posting.
• Direct denial prevention, denial recovery, appeals management, and payer dispute resolution.
• Monitor aging accounts receivable and develop corrective action plans.
• Review reimbursement trends and recommend operational improvements.

FQHC Reimbursement & Compliance

• Maintain expertise in FQHC reimbursement methodologies.
• Ensure compliance with HRSA requirements and the Sliding Fee Discount Program.
• Complete and implement annual fee schedule reviews per policy.
• Oversee Medicaid and Medicare billing and wraparound payment processes.
• Support annual Uniform Data System (UDS) reporting requirements.
• Coordinate revenue cycle-related audits and corrective action plans.
• Monitor changes in reimbursement regulations and ensure the organization is ready.

EHR/EDR Systems Administration

• Provide leadership and oversight for the organization's practice management and revenue cycle technology systems.
• Partner with clinical, dental, operations, finance, quality, and IT leaders to ensure systems support efficient workflows, accurate billing, regulatory compliance, and quality patient care.
• Lead EHR and EDR optimization initiatives to improve documentation, charge capture, coding accuracy, reimbursement, and revenue cycle performance.
• Oversee system upgrades, workflow changes, and new technology implementations.
• Oversee vendor relationships for practice management, clearinghouse, and RCM systems.
• Ensure appropriate user training, change management, and adoption of system best practices.

Analytics & Reporting

• Develop benchmarks and productivity standards across revenue cycle functions.
• Analyze trends and identify opportunities to improve operations.
• Provide regular reporting to organizational leadership.
• Utilize data-driven decision-making to improve financial outcomes.

Additional Requirements:

• Grants are vital to ECH revenues and directly or indirectly support all positions. This role may include responsibilities closely associated with grant deliverables. Grants and grant responsibilities may change over time.
• Complete all required training as designated by HR and the position supervisor.
• Adhere to all organizational policies and those outlined in the ECH Employee Handbook.
• Comply with all ECH Vaccine Mandates.
• Willingness to travel and work at other ECH locations as determined by the supervisor.
• Comply with all applicable Credentialing and Privileging requirements in a timely manner.
• Embrace the ECH Mission and Vision and agree to work within the ECH Guiding Principles and the principles set by the position supervisor.
• Must participate in quality assurance/ improvement activities when applicable.

Qualifications:
To perform this job successfully, an individual must satisfactorily perform each essential duty. The requirements below represent the required knowledge, skills, and/or abilities. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Education/Experience:

Must-haves to be successful:

• Bachelor's degree or equivalent combination of education and experience.
• 7 years' experience in revenue cycle management, including billing and coding
• 5 years of supervisory experience required
• Industry certification is required and may include 1) AAPC® certifications (www.aapc.com) including the Certified Professional Coder® or the Certified Professional Biller™, 2) HFMA™ certifications (www.hfma.com) including the Certified Healthcare Financial Professional or Certified Revenue Cycle Representative, or 3) AHIMA® certifications (www.ahima.org) including the CDIP® or CCS®/CCS-P®.
• Knowledge of CPT®, CDT®, HCPCS and ICD10 required
• Knowledge of CO Medicaid, Medicare, and other public health benefits programs
• Knowledge of the relevant chapters of the HRSA Health Center Program Compliance Manual including Sliding Fee Program and Billing Compliance (bphc.hrsa.gov/compliance)
• Experience with electronic Medical and Dental Office Practice Management systems
• Proven management and people skills with exemplary performance recommendations regarding patient, peer, and management interactions
• Ability to analyze financial and statistical information required
• Ability to work under pressure and handle multiple tasks at one time, including delegation of responsibility and authority as required
• Ability to define problems, collect data, establish facts, and draw valid conclusions.

Nice to have:

• Previous experience in a community health center (FQHC)
• Experience with Power BI or other data aggregation platforms
• Experience with OCHIN EPIC, Dentrix, and Quadax platforms
• Experience leading EHR optimization, revenue cycle technology, analytics, interoperability, or clinical informatics initiatives.
• Bilingual (English/Spanish) is preferred.

Work Environment:
The work environment in a healthcare setting can be fast-paced and involves working directly with patients and healthcare professionals. The individual may also work in a clerical setting. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job. The work environment noise level is usually moderate.

Physical Demands:
The physical demands described here represent those that an employee must meet to perform the essential functions of this job successfully. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Summary

Why Join Us?

• Live, work, and play in 'Colorado's Playground'! Summit County offers four world-class ski resorts, with Vail Resort just 45 minutes away. With rivers, lakes, hiking, and mountain biking trails, it's a paradise for outdoor enthusiasts. Year-round activities include skiing, snowboarding, cross-country skiing, snowshoeing, snowmobiling, hiking, mountain biking, rafting, fishing, and boating. Music, art, cultural, and social events are plentiful. The communities include Frisco, Breckenridge, Dillon, and Silverthorne, with ski resorts like Breckenridge, Copper Mountain, Keystone, and Arapahoe Basin. This is your dream job location!
  
• Mission-Driven Work: Be part of a nationally recognized Federally Qualified Health Center (FQHC) providing integrated medical, dental, and behavioral health services in a collaborative team-based model of care.
  
• Work-Life Balance: Enjoy a flexible schedule supporting professional growth and outdoor adventure.
  
• Competitive compensation: Attractive salary, benefits, and bonus potential.
  
• Loan Repayment Opportunities: We offer loan repayment assistance for qualifying candidates.
  
• Growth Opportunities: We're committed to helping you grow professionally through continued education and development.
  
• Insured group health, dental, and vision plans.
  
• 401 (k) retirement plan with employer match.
  
• Employer-paid life, AD&D, and long-term disability plans.
  
• Paid Time Off (PTO), paid holidays, one floating holiday, and sick pay.
  
• Free access to confidential resources through an Employee Assistance Program (EAP).
  
• Additional voluntary benefits include accident insurance, critical illness insurance, short-term disability insurance, and group pet insurance.
  
• Lifestyle Spending Account for full-time employees.
  
• Fringe benefits like a shared ski medallion, a discounted Rec Center membership, and more.