<p>POSITION SUMMARY:</p> <p>The Revenue Cycle Manager is responsible for overseeing and optimizing the end-to-end revenue cycle processes at Family Health Center of Worcester (FHCW), a Federally Qualified Health Center (FQHC) that recently implemented the Epic electronic health record (EHR) system and outsources billing operations to a third-party vendor. This role ensures the integrity and performance of revenue capture, claim submission, denial management, and cash posting workflows in coordination with internal departments and external billing partners. The ideal candidate is an experienced revenue cycle leader who understands FQHC reimbursement models and is comfortable navigating Epic in a multi-vendor, collaborative environment.</p> <p>ESSENTIAL DUTIES AND RESPONSIBILITIES:</p> <ul> <li>Serve as the primary liaison with the outsourced billing vendor to ensure accurate, timely, and compliant claim processing, denial resolution, and collections. Monitor and enforce performance standards, KPIs, and SLAs related to vendor performance. </li><li>Review and escalate vendor issues that impact cash flow or compliance. </li><li>Ongoing process improvement analysis and implementation of system improvements, with a particular focus on prioritization of revenue-by-revenue type. </li><li>Analyze claims data and suggest/implement procedures to maximize UDS/HEDIS and incentive revenue collections (i.e., ICD-10 and CPT modifiers). </li><li>Compile requested statistical, financial, billing, or auditing reports. </li><li>Identifies, analyzes, and addresses challenges and/or breakdowns in the revenue cycle process causing denials or delayed payments. </li><li>Perform ongoing trend analysis of factors impacting revenue, including payer rejections and denials. </li><li>Conduct internal audits and reviews to assess coding accuracy, encounter completeness, and billing documentation. </li><li>Collaborates with Executive, Clinical, Operations, Information Technology, and Compliance teams to integrate and optimize revenue cycle management across functions in the organization </li><li>Work with EHR vendor on Electronic Interchange (EDI) issues and system upgrades to maximize practice management system utilization. </li><li>Collaborate closely with the Finance Department to contribute to cash reconciliation activities and assist in assessing accounts receivable collectability and validation, including the writing off of bad debts. </li><li>Participate in strategic initiatives, quality improvement, and grant reporting projects as needed. </li><li>Perform the review of contracted rates vs. reimbursements. </li><li>Creates and develops reports to address management needs; analyze information to identify trends or issues. </li><li>Implement industry best practices, benchmarks, and tools for reimbursement, denial management, collections, billing, claims, and other Revenue Cycle processes. </li><li>Track key revenue cycle metrics (e.g., days in AR, denial rates, clean claim rate, net collections) and report performance to CFO and leadership. </li><li>Other duties as assigned. </li></ul> <p>QUALIFICATIONS</p> <p>Education & Experience:</p> <ul> <li>Education: A bachelor's degree in health administration, finance, business, or a related field is required. Master's preferred. </li><li>Experience: Minimum 5 years of experience in healthcare revenue cycle management, including experience in an FQHC or community health setting preferred. Experience working with Epic revenue cycle modules required. </li><li>Strong knowledge of Medicaid, Medicare, commercial payer rules, and FQHC reimbursement models (e.g., PPS, wraparound, sliding fee). </li><li>Strong analytical, communication, and problem-solving skills. </li><li>Ability to work across departments to improve workflows, data quality, and compliance. </li><li>Certifications: Certified coder, coding education experience preferred. </li></ul> <p>Knowledge, Skills, and Abilities:</p> <ul> <li>Knowledge of third-party payer requirements, including federal, state, and private health care plans and authorization process. </li><li>Knowledge of basic insurance policies, procedures, and reimbursement practices with Medicare coding. </li><li>Excellent verbal and written skills. </li><li>Excellent interpersonal and customer service skills. </li><li>Excellent organizational skills and attention to detail. </li><li>Excellent time management skills with a proven ability to meet deadlines. </li><li>Strong analytical and problem-solving skills. </li><li>Ability to prioritize tasks and delegate when appropriate. </li><li>Proficient with Microsoft Office Suite or related software. </li></ul> <p>Monday - Friday; 8:30am -5:00pm</p>