Director of Revenue Cycle Management
Description
Petaluma Health Center's mission is to provide high quality health care with access for all in Southern Sonoma County & West Marin. We pride ourselves on our Patient-Centered care while maintaining an engaging environment for our staff. The Center accomplishes this mission through collaborative, innovative programs, services and referral resources that meet the economic needs of the entire community.
FULL TIME EMPLOYEE BENEFITS:
- 21 Days of Paid Time Off
- 10 Observed Holidays
- Medical Insurance (Entire deductible paid by us!)
- 30 Chiropractor and Acupuncture visits per year included with enrollment in our health insurance plans (Kaiser and WHA)
- Dental Insurance
- Vision Insurance
- Gym Membership Discounts at Active Wellness Center and 24-Hour Fitness!
- 401K Matching after 1 year of employment
- Flexible Spending Account, Dependent Care FSA
- Life Insurance (included at no cost to the employee)
- Long Term Disability (included at no cost to the employee)
- Employee Assistance Program (included at no cost to the employee)
Summary: The Director of Revenue Cycle Management provides strategic and operational leadership for all revenue cycle and payor enrollment functions within Petaluma Health Center (PHC) and ensures accurate, timely, and compliant reimbursement across all payor sources. This role oversees the full revenue cycle and provider enrollment lifecycle while serving as a key partner to clinical, finance, compliance, and operational leaders. A key focus of this position is leading and developing high-performing revenue cycle and enrollment teams. The Director will work cross-functionally with other departmental leaders to ensure regulatory compliance and maximized reimbursement. The Director drives accountability, strengthens internal controls, mitigates revenue risk, and advances PHC’s financial sustainability in support of its mission.
Areas of Responsibilities:
Revenue Cycle Leadership
- Provide strategic direction and oversight for all revenue cycle functions including coding, charge capture, billing, collections, payment posting, denial management, etc.
- Develop, implement, and monitor revenue cycle policies, procedures, and workflows to improve financial performance and operational efficiency.
- Analyze key performance indicators such as: Days in A/R, clean claim rate, denial rates, net collection rate, and cash flow; implement corrective action plans as needed.
- Ensure accurate and timely billing in compliance with Medicare and Medi-Cal PPS systems and sliding fee discount program requirements.
- Oversee charge integrity and collaborate with clinical teams to ensure accurate documentation and coding practices.
Payor Enrollment
- Direct and oversee all provider and payor enrollment and revalidation.
- Ensure timely enrollment of new providers to prevent revenue delays or losses.
- Maintain compliance with CMS, Medi-Cal, and commercial enrollment requirements, including recredentialing and revalidation.
- Serves as the primary escalation point for complex enrollment issues impacting reimbursement.
Compliance and Risk Management
- Ensure compliance with federal and state regulations, including HRSA, CMS, Medi-Cal, OIG, and payor-specific requirements.
- Partner with Compliance, Quality, and Clinical Leadership to support audits, site visits, and corrective action plans related to billing and enrollment.
- Monitor regulatory changes affecting FQHC reimbursement and payor enrollment and lead implementation of necessary operational changes.
Financial and Operational Collaboration
- Collaborate with Finance, Clinical Operations, and IT leadership to align revenue cycle processes with organizational goals.
- Participate in budgeting, forecasting, and financial planning related to revenue cycle performance.
- Support contract management and payor negotiations by providing data analysis and reimbursement insights.
Team Leadership and Development
- Lead, mentor, and develop revenue cycle and payor enrollment staff, fostering accountability, engagement, and continuous improvement.
- Establish performance goals, conduct evaluations, and support ongoing training and professional development.
- Promote a culture of service excellence, compliance, and mission-driven performance.
- Ensure adequate staffing levels and appropriate knowledge and skillsets amongst the revenue cycle and provider enrollment functions.
Education/Experience:
- Bachelor’s degree in business, Finance, Accounting, Health Management or related field, or equivalent experience required
- Master's degree (MBA or MHA) preferred
- Five years of experience managing the provider enrollment function in a Federally Qualified Health Center in California preferred
- Seven or more years of experience managing the patient revenue function of at least an $80M, multi-site, Federally Qualified Health Center in California strongly preferred
- Certified Revenue Cycle Specialist/Professional/Executive certification strongly preferred
- Certified Coder Certificate strongly preferred
- Five years of experience managing the practice management system within OCHIN’s instance of Epic preferred
Desired Skills:
- Ability to function effectively as a member of an inter-professional team
- Ability to assess competency, manage, and develop exempt and non-exempt staff
- Ability to assess and improve the functionality of all areas of the patient revenue cycle
- Ability to assess and improve the payor enrollment lifecycle
- Ability to use data and information technology to manage and improve the patient revenue cycle function
- Excellent communication skills, both written and verbal
- Exceptional organizational, time, and project management skills
- Culturally competent and sensitive to the needs of a multi-cultural workforce and patient population
- High level of integrity, accountability, and attention to detail
Language Skills: Ability to effectively present information and respond to questions and requests from patients, co-workers, and others as necessary. Bilingual in English and Spanish, both written and verbal preferred.
Petaluma health Center is an Equal Opportunity Employer. Petaluma health Center does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.