The Director of Revenue Cycle provides strategic, operational, and financial leadership for all revenue cycle management (RCM) functions across a large, multi-site FQHC. This position oversees end-to-end revenue cycle operations for an organization serving approximately 200,000 patient visits annually with a clinical network of approximately 300 clinicians.
The Director is responsible for optimizing financial performance, cash flow, and regulatory compliance across a complex, multi-service clinical model that includes
Family Practice, Dental, Optometry, Behavioral Health Therapy, ASAM (Addiction/SUD Services), and OB/GYN services.
This role requires a highly analytical, mission-driven leader with extensive experience navigating FQHC regulations (PPS billing, HRSA compliance, sliding fee programs) and high-volume billing across both medical and behavioral health specialties.
Key ResponsibilitiesStrategic Leadership & Financial Performance - Develop, implement, and continuously improve a unified, organization-wide revenue cycle strategy aligned with financial sustainability and HRSA compliance objectives.
- Serve as the principal advisor to the executive leadership team on RCM performance, regulatory updates, and emerging reimbursement models.
- Monitor and manage key performance indicators (KPIs) including Days in A/R, Clean Claim Rate, Denial Rate, Net Collection Rate, and Cost to Collect.
- Lead annual revenue cycle budgeting, forecasting, and goal-setting processes for all service lines.
- Collaborate cross-functionally with Clinical, Operations, IT, Compliance, and Finance leadership to align clinical documentation with optimal charge capture.
Revenue Cycle Operations & Service Line Management - Oversee all daily front-end and back-end revenue cycle operations, including patient registration, insurance verification, sliding fee scale (SFS) assessment, copay collection, coding, billing, claims submission, payment posting, and collections.
- Standardize and manage billing, coding, and workflow requirements across a highly diverse set of clinical specialties:
- Family Practice: FQHC Prospective Payment System (PPS) reimbursement, sliding fee discounts, preventive care, and preventive-to-chronic care transition billing.
- Behavioral Health (Therapy & ASAM): Multi-level addiction treatment, counseling, psychiatric evaluation, intensive outpatient program (IOP) billing, and 1115 Waiver models.
- Dental: CDT coding, FQHC dental encounters, and pediatric/adult Medicaid dental guidelines.
- Optometry: Coordination of vision hardware plans versus medical eye care insurance benefits.
- OB/GYN: Global OB billing packages, maternal health programs, and state-specific perinatal programs.
- Implement best-practice workflows to minimize denials and maximize first-pass claim rates.
Compliance, Audit & Regulatory Oversight - Ensure full compliance with HRSA Section 330 grant requirements, UDS reporting mandates, PPS guidelines, and sliding fee discount program policies.
- Maintain compliance with Federal and State regulations, including HIPAA, CMS guidelines, Medicaid/Medicare billing rules, and behavioral health parity laws.
- Partner with the Compliance Officer to design and execute regular internal coding and documentation audits, ensuring any identified vulnerabilities are quickly addressed.
- Stay current on state-specific Medicaid Managed Care Organization (MCO) rules and changing reimbursement guidelines.
Team Leadership & Staff Development - Recruit, train, mentor, and evaluate a high-performing, multi-functional revenue cycle team across multiple departments and clinic sites.
- Establish clear performance standards, productivity metrics, and quality expectations for all billing, coding, and RCM support staff.
- Foster a collaborative culture of accountability, continuous learning, and professional growth.
- Provide continuous training and education to RCM staff and clinical providers on documentation, coding standards, and payer guidelines.
Technology & Electronic Health Record (EHR) Optimization - Direct the operational optimization and integration of the Epic Electronic Health Records (EHR) and Practice Management (PM) systems.
- Evaluate, select, and implement automated RCM tools, clearinghouses, predictive denial management systems, and online patient billing integrations to drive operational efficiency.
- Collaborate with IT and clinic leadership to troubleshoot system issues affecting claim submission or charge capture.
Payer Relations, Contracting & Credentialing - Maintain and cultivate strategic relationships with key payers, including Medicaid MCOs, Medicare, commercial insurers, and state/county funding agencies.
- Oversee the centralized provider credentialing and enrollment process to ensure timely clinician participation and prevent administrative write-offs.
- Support contract negotiations by providing comprehensive, data-driven analysis of payer reimbursement performance, denial trends, and contract compliance.
Reporting, Analytics & Business Intelligence - Develop, maintain, and present comprehensive RCM dashboards and performance reports to executive leadership and the Board of Directors.
- Utilize advanced data analytics to perform root-cause analyses on billing denials, underpayments, and lagging accounts receivable.
- Ensure accurate financial data reporting to support internal audits, external cost reports, and HRSA/UDS submissions.
Qualifications Education/Certifications: - Bachelor's degree in Healthcare Administration, Business Administration, Finance, Accounting, or a related field required. Master's degree (MHA, MBA, or equivalent) is highly preferred.
- Certifications (Preferred): Professional certification such as Certified Revenue Cycle Professional (CRCP), Certified Professional Biller (CPB), Certified Professional Coder (CPC), or Fellow of the Healthcare Financial Management Association (FHFMA/CHFP).
Experience - Leadership Experience: Minimum of 7-10 years of progressive revenue cycle experience, with at least 5 years in a director-level or senior leadership role within a healthcare system.
- Large-Scale Operations: Proven experience managing RCM in a high-volume setting.
- FQHC/Ambulatory Care Expertise: Highly preferred. Candidates must demonstrate deep knowledge of the FQHC Prospective Payment System (PPS) reimbursement, Sliding Fee Discount Program rules, and HRSA guidelines.
- Specialized Service Lines: Direct experience overseeing billing/coding for behavioral health (specifically including ASAM/SUD treatment) alongside traditional medical, dental, and optometry services.
Knowledge, Skills & Abilities - Comprehensive mastery of electronic billing systems, clearinghouses, and practice management databases.
- In-depth understanding of CPT, ICD-10-CM, CDT, and DSM-5 coding conventions.
- Exceptional analytical, problem-solving, and financial forecasting skills.
- Strong interpersonal and communication skills, with the ability to influence positive change across clinical, operational, and financial teams.
- Absolute commitment to the mission of providing high-quality healthcare to underserved, vulnerable, and diverse patient populations.
Why You'll Love Working Here- Purpose-driven work that directly impacts access to care across our communities
- Robust benefits package (medical, dental, vision) designed to support you and your family
- Generous PTO because we believe caring for others starts with caring for yourself
- 401(k) with employer contribution to help you plan for what's ahead
- Life and disability coverage for peace of mind
Here, you are not just filling a role-you are helping shape healthier communities and advancing equitable care every day!
