Revenue Cycle Manager

Position Summary: An FQHC Revenue Cycle Manager oversees and optimizes the entire revenue cycle process for a Federally Qualified Health Center, from patient registration to final payment, while ensuring FQHC-specific compliance. Key responsibilities include ensuring claims are submitted accurately and promptly, resolving denials, and producing reports. The role requires a strong knowledge of FQHC, Medicare, and Medicaid billing regulations, as well as proficiency in EHR systems and data analysis.

Essential Duties And Responsibilities: Billing and collections: Oversee the entire billing process, including charge capture, claims submission, payment posting, and denial management to maximize reimbursement and improve cash flow. This also involves implementing and maintaining clean claims processing protocols. Compliance and auditing: Ensure compliance with FQHC regulations, including Medicare/Medicaid billing codes, the Prospective Payment System (PPS), and the 340B drug pricing program. Reporting and analysis: Monitor and report on key revenue cycle metrics, such as accounts receivable (A/R) days, denial rates, and collection rates, presenting findings. Training: Educate providers and front-desk staff on documentation and billing practices. Payer relations: Manage relationships with insurance companies and government payers, resolve payment disputes, and stay informed about policy changes. Process improvement: Identify and implement opportunities to improve efficiency within the revenue cycle through new procedures, software, and automation. Sliding fee program: Oversee the FQHC's sliding fee discount program for uninsured and underinsured patients, ensuring compliance with federal guidelines. System management: Manage and optimize the use of electronic health record (EHR) and billing software, such as Epic or eClinicalWorks. Other duties as assigned which are necessary to maintain TCA Health's efficiency.

Education: A bachelor's degree in healthcare administration, finance, or a related field is often preferred, but a candidate with significant experience may qualify.

Experience: Typically requires 5+ years of experience in healthcare revenue cycle management Experience working in an FQHC or community health setting is strongly preferred. Specialized knowledge: Must have a deep understanding of FQHC-specific billing requirements, reimbursement methodologies (like PPS), and government programs such as Medicaid and Medicare.

Technical skills: Proficiency with EHR/billing systems, data analytics, and Microsoft Office Suite (especially Excel) is essential. Soft skills: Strong analytical, problem-solving, and communication skills are necessary for success in this role.