Director of Revenue Cycle Management

About the role

The HealthCare Connection (THCC) is a Federally Qualified Health Center (FQHC) founded in 1967. Our mission is to provide quality and accessible primary healthcare services through community responsive approaches that address financial, geographic, and other barriers to care for residents of northern Hamilton County and surrounding areas. THCC is recognized as a Level 3 Patient Centered Medical Home (PCMH).

Responsibilities

• Direct and oversee all revenue cycle operations including registration, charge capture, coding, billing, claims processing, payment posting, denial management, collections, and reimbursement analysis.
• Lead revenue cycle strategy and performance improvement initiatives to maximize cash flow, reduce denials, and improve financial outcomes.
• Monitor and analyze key revenue cycle metrics including A/R trends, denial rates, clean claim rates, payer mix, days in A/R, and collection performance.
• Ensure compliance with FQHC billing regulations, HRSA requirements, Medicare, Medicaid, commercial payer guidelines, and other applicable regulatory standards.
• Oversee coding compliance and risk-adjustment capture (HCC) efforts in collaboration with providers and coding staff.
• Manage relationships and accountability with third-party billing vendors, clearinghouses, and payer representatives.
• Develop and implement policies, procedures, workflows, and internal controls related to revenue cycle operations.
• Partner with clinical and operational leadership to improve documentation accuracy, charge integrity, and reimbursement outcomes.
• Cook up payer credentialing oversight and support contracting initiatives as needed.
• Lead audits, payer reviews, repayment responses, and corrective action planning when necessary.
• Prepare and present revenue cycle reports, financial analyses, and operational updates to executive leadership.
• Identify opportunities for workflow optimization, automation, EHR improvements, and operational efficiencies.
• Support annual budgeting, forecasting, and financial planning activities related to patient revenue.
• Supervise, mentor, and evaluate revenue cycle staff while fostering accountability and professional development.
• Maintain confidentiality and ensure compliance with HIPAA and organizational policies.

Requirements

• Bachelor’s degree in healthcare administration, business, finance, health information management, or related field preferred; equivalent experience may be considered.
• Minimum of 5 years of progressive revenue cycle experience in healthcare required.
• Minimum of 2 years of leadership or supervisory experience required.
• Strong knowledge of CPT, HCPCS, ICD-10, FQHC billing regulations, PPS reimbursement methodologies, Medicare, Medicaid, and commercial payer requirements.
• Experience managing denials, payer audits, appeals, and reimbursement optimization initiatives.
• Knowledge of coding compliance and documentation improvement practices.
• Strong analytical, organizational, communication, and problem-solving skills.
• Experience working with EHR and practice management systems.
• Ability to collaborate effectively with clinical, operational, and financial leadership teams.

Qualifications

• Federally Qualified Health Center (FQHC) experience strongly preferred.
• Certified Professional Coder (CPC), Certified Revenue Cycle Representative (CRCR), Certified Coding Specialist (CCS), or related certification preferred.
• Experience overseeing outsourced billing vendors.
• Familiarity with NextGen, EPIC, or similar healthcare systems.
• Experience with value-based care, quality incentive programs, and risk-adjustment methodologies.