Job Type
Full-time
Description
JOIN OUR TEAM! Community Health Care is a privately owned corporation that has a 39-year history of providing our patients with the highest quality of innovative, comprehensive health care, and health care services, that are compassionate, support, personal, convenient, and cost effective. We are actively engaged in the communities that we serve and strive to recruit the finest staff possible, giving maximum support and encouragement to foster growth and pride in the organization.
We are seeking a detail-oriented and strategic Revenue Cycle Manager to work in office to oversee and optimize all aspects of the revenue cycle for our network of primary care practices operating under value-based and risk-based contracts. The ideal candidate will have experience managing revenue cycle functions in a healthcare setting, strong knowledge of value-based care payment models (such as capitation, shared savings, and downside risk), and a passion for driving financial performance and operational efficiency. This role also includes direct oversight of our third-party billing company, ensuring alignment with organizational goals, contract requirements, and performance metrics.
Key Responsibilities: - Oversee end-to-end revenue cycle processes including patient registration, insurance verification, coding, charge capture, claims submission, payment posting, denial management, and patient collections.
- Manage the relationship with the third-party billing company, ensuring timely follow-up on claims, accuracy in charge entry and coding.
- Manage workflows to optimize performance under risk-based contracts, ensuring accurate documentation, attribution, risk adjustment (RAF scores), and reporting.
- Collaborate with clinical and administrative teams to align care delivery with contract requirements and financial incentives.
- Analyze key performance indicators (KPIs) related to revenue cycle performance, including AR days, denial rates, clean claim rates, and collections.
- Lead initiatives to reduce claim denials and improve cash flow through process improvements and staff education.
- Ensure compliance with federal, state, and payer-specific billing and coding regulations, especially those relevant to value-based care arrangements.
- Maintain relationships with payers to resolve issues, negotiate terms, and stay current on contract changes.
- Provide regular reporting to leadership on revenue trends, performance against risk-based contracts, and opportunities for improvement.
- Develops, writes and updates departmental policies and procedures in alignment with organizational standards.
- Supervise and mentor revenue cycle team members, fostering a culture of accountability and continuous improvement.
Qualifications: - Minimum 5 years of experience in healthcare revenue cycle management, with at least 2 years in a value-based or risk-based care environment.
- Experience supervising direct reports.
- Strong understanding of capitated payments, shared savings models, HCC coding, and risk adjustment.
- Proven experience with revenue cycle software.
- Excellent analytical, communication, and leadership skills.
- Certification in medical coding and billing (e.g., CPC, CPB, CRCR).
Preferred Attributes: - Experience working in a primary care group or multi-site healthcare organization.
- Ability to interpret complex payer contracts and understand financial implications.
- Knowledge of quality metrics (e.g., HEDIS, STAR ratings) and their impact on reimbursement.
Benefits: - Excellent Medical insurance
- 401(k) and Roth 401(k)
- 401(k) employer match
- Dental insurance
- Term Life Insurance
- Vision insurance
- Wellness benefits
- Paid time off
- Personal days
- Short term disability
- Long Term disability
- Paid holidays
- Employee assistance program
