Revenue Cycle Manager

Job Purpose

The Revenue Cycle Manager is responsible for providing strategic and operational leadership for the organization's entire revenue cycle, from patient scheduling and registration through final claim resolution and payment collection. This position oversees all revenue cycle functions and serves as the organization's subject matter expert on revenue cycle operations, reimbursement, payer requirements, patient financial processes, and revenue optimization.

Duties & Responsibilities

• Provide leadership and oversight for all revenue cycle functions, including patient registration, insurance verification, eligibility determination, prior authorization support, charge capture, coding, billing, payment posting, denial management, accounts receivable management, and collections.
• Monitor and evaluate revenue cycle performance through key performance indicators (KPIs), productivity metrics, reimbursement trends, and financial outcomes.
• Develop and implement strategies to improve cash flow, reduce denials, reduce days in accounts receivable, improve clean claim rates, and maximize reimbursement.
• Ensure accurate and timely claim submission, payment posting, follow-up, and resolution of outstanding accounts.
• Identify revenue cycle risks and develop corrective action plans to address operational, financial, and compliance concerns.
• Cross-Functional Collaboration and Workflow Development
• Collaborate with organizational leaders to develop, implement, and maintain efficient revenue cycle workflows across all service lines and departments.
• Partner with Front Office, Clinical Operations, Behavioral Health, Dental, Pharmacy, Quality, Compliance, Information Technology, and Finance to identify workflow gaps and implement solutions.
• Serve as a resource for revenue cycle-related operational questions and assist departments in resolving complex billing, reimbursement, eligibility, and payer issues.
• Participate in organizational initiatives that impact revenue cycle performance, patient access, reimbursement, or regulatory compliance.
• Facilitate cross-functional discussions to clarify workflow ownership, accountability, and process expectations.

Qualifications

• Required Qualifications:
• Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, Health Information Management, or a related field; equivalent combination of education and relevant experience may be considered.
• Minimum of five (5) years of progressively responsible experience in revenue cycle management, healthcare operations, medical billing, reimbursement, or related healthcare financial functions.
• Minimum of three (3) years of supervisory, management, or leadership experience.
• Demonstrated knowledge of healthcare revenue cycle operations, including patient registration, insurance verification, eligibility determination, charge capture, coding, claims submission, payment posting, denial management, accounts receivable, and collections.
• Strong knowledge of Medicare, Medicaid, commercial insurance, payer requirements, reimbursement methodologies, and revenue cycle best practices.
• Experience analyzing revenue cycle performance metrics, identifying operational opportunities, and implementing process improvements.
• Demonstrated ability to develop policies, procedures, workflows, training materials, and educational resources.
• Strong analytical, critical thinking, problem-solving, and decision-making skills.
• Excellent written, verbal, interpersonal, and presentation skills.
• Demonstrated ability to collaborate effectively with leaders, providers, clinical staff, operational departments, and external stakeholders.
• Proficiency with electronic health records (EHRs), practice management systems, payer portals, Microsoft Office applications, and revenue cycle reporting tools.
• Ability to maintain confidentiality and exercise sound judgment when handling sensitive information.

Preferred Qualifications

• Master's degree in Healthcare Administration (MHA), Business Administration (MBA), Public Health (MPH), Finance, or a related field.
• Experience working in a Federally Qualified Health Center (FQHC), Community Health Center, Rural Health Clinic, or similar healthcare environment.
• Knowledge of FQHC reimbursement methodologies, PPS/APM billing, Medicare Annual Wellness Visits, value-based care programs, and Medicaid managed care plans.
• Professional certification such as CRCR (Certified Revenue Cycle Representative), CHFP (Certified Healthcare Financial Professional), CPC, CPB, or other relevant healthcare revenue cycle certification.
• Experience leading cross-functional projects, workflow redesign initiatives, and organizational change management efforts.

Physical Requirements & Working Conditions

Work is primarily performed in a professional office and healthcare environment with frequent interaction with employees, patients, providers, leadership, payers, and external partners. Regular use of computers, telephones, printers, scanners, and other standard office equipment is required. Frequently communicates with employees, patients, and other stakeholders and must be able to exchange accurate information in these interactions. Regularly reviews, prepares, and analyzes reports, documentation, and electronic records. May move throughout Heartland facilities to attend meetings, collaborate with staff, or support operational needs. Frequently remains in a stationary position while performing computer-based and administrative work. Work requires attention to detail, problem-solving, decision-making, and the ability to manage multiple priorities in a fast-paced environment. Must be able to perform the essential functions of the position with or without reasonable accommodation.