Revenue Cycle Director

Job ID: 12345

About the Role

The Revenue Cycle Director is responsible for planning, directing, and coordinating Spring Branch Community Health Center’s reimbursement strategy. This position oversees all revenue cycle operations, including call center, patient scheduling, eligibility, insurance verification, front desk, billing, collections, and financial planning for patients. The role requires collaboration with clinical, operations, finance, human resources, and credentialing departments to foster a positive and supportive environment. The Revenue Cycle Director presents billing activity reports clearly and works closely with the CFO to achieve best-in-class health center metrics.

Qualifications

• Bachelor’s degree in health care administration or related field from an accredited university.
• Four years of health care revenue cycle experience, preferably in a federally qualified health center (FQHC), performing the essential duties described.
• Current knowledge of FQHC/medical office practices, procedures, billing programs, compliance, fraud, and abuse rules related to billing and collecting with Federal, State, and third-party payers.
• Minimum of three years of supervisory experience.
• Ability to analyze complex data, including fiscal and performance data, and communicate results effectively.
• Proficiency in Microsoft Office Suite and practice management/electronic health records systems, preferably eClinical Works.
• Strong oral and written communication skills, with the ability to work well with all levels of staff.

Responsibilities

• Provide oversight and supervision to all revenue cycle managers, including call center, eligibility, front desk, insurance verification, and billing.
• Support the full revenue cycle through data collection, reporting, analytics, and KPI monitoring.
• Manage department budgets and regular reporting requirements.
• Coordinate with clinical operations to reduce preventable errors, minimize payment denials, and improve patient care and experience.
• Safeguard the security of cash payments and collection of patient accounts; monitor accounts sent for collection and reimbursement from Federal, State, insurance, or other third-party payers; review, evaluate, and verify payment accuracy and enrollment compliance; investigate and resolve discrepancies.
• Approve and sign off on all department-related expenses, patient refunds, and reimbursement of overpaid fees to insurance carriers.
• Maintain compliance and prevent fraud and abuse issues related to billing and collecting patient revenues; keep staff updated on compliance matters.
• Manage merchant services vendor contracts for patient payment and collection activities.
• Manage the clearinghouse vendor relationship and maximize available services.
• Work with the Accounting Department to maximize utilization of Texas Health and Human Services contract funding.
• Conduct annual reviews and updates of the fee schedule (charge master) and sliding fee discount schedules.
• Conduct semi-annual reviews of all insurance contracts and evaluate opportunities for new contracts.
• Coordinate ongoing provider documentation and coding training.
• Promote SBCHC pharmacy services to all patients.
• Identify opportunities to increase revenue from current services.
• Research and identify new revenue sources, such as billing fee-for-service outside of FQHC reimbursement.
• Develop and implement procedures for billing and collection from new service lines, such as optometry, case management, and nutrition services.
• Develop and monitor revenue cycle KPIs.
• Participate in organizational strategic planning activities; serve on committees and task forces; attend meetings and conferences as assigned.
• Develop, maintain, and enforce departmental policies, procedures, and work practices to ensure accuracy of patient demographic, financial, and insurance data.
• Ensure maximization of collections, accuracy of account numbers, billing system integrity, signature authority, codes, and insurance status within legal and compliance frameworks.
• Work with the Accounting Department to ensure accurate and timely recording of patient revenue and collections.
• Formulate systematic retention, protection, transfer, and disposal of billing records.
• Coordinate with the IT department and software vendors to monitor and ensure data integrity within the practice management system.
• Manage the Practice Management side of the billing system.
• Lead process improvement of billing functions using resource sharing and input from sister network FQHCs.
• Lead the implementation of automation and artificial intelligence (AI) to maximize reimbursements and collections.
• Lead special projects as assigned.
• Conduct performance reviews for assigned staff.
• Perform other duties as assigned by the CFO and/or CEO.
• Participate in emergency and disaster response responsibilities, including assignment to an emergency response team.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Short-term disability insurance
• Long-term disability insurance
• Critical Illness insurance
• Hospital Indemnity insurance