Director of Revenue Cycle

The Director of Revenue Cycle leads the billing and revenue functions of the Finance Department. This role makes sure all revenue is captured, billed correctly, recorded accurately, and reconciled. It also oversees the Sliding Fee Discount Program and revenue-generating contracts.
The Director works to improve cash flow, strengthen internal controls, and maximize reimbursement. This work supports our mission to provide accessible, high-quality, affordable healthcare to underserved populations.
All revenue cycle work must follow federal and state rules, HRSA Health Center Program requirements, FQHC reimbursement methods, payer contracts, and Center policy.

• Build and maintain processes to capture all eligible revenue across medical, dental, behavioral health, enabling, and other services.
• Monitor charges, coding, and billing data for accuracy and completeness to prevent missed charges and lost revenue.
• Review payer payments against contract terms to find underpayments, missed reimbursement, and billing process gaps.
• Create revenue integrity reports and conduct routine reviews to confirm services are billed according to payer rules and Center policy.
• Track changes in payer rules, billing requirements, and FQHC payment methods, and update workflows as needed.

• Make sure patient service revenue, contractual allowances, adjustments, payments, refunds, and accounts receivable are recorded and reconciled accurately.
• Reconcile the EHR, practice management and billing systems, clearinghouse reports, remittance advice, bank deposits, and general ledger.
• Lead daily, monthly, and year-end reconciliations of charges, payments, adjustments, credit balances, refunds, and accounts receivable.
• Review and approve contractual allowances, payer adjustments, bad debt, and sliding fee discounts for correct classification and documentation.
• Make sure all patient payments, insurance payments, and electronic remittances reach the billing team promptly for posting.
• Work with the CFO and Accounting to set revenue recognition procedures, internal controls, and methods for estimating contractual allowances and net patient service revenue under GAAP.
• Support monthly and year-end close, external audits, and cost reports.
• Maintain documentation and audit trails for revenue transactions, adjustments, payment allocations, reconciliations, and approvals.
• Write policies and procedures that clearly divide responsibilities among Billing, Revenue Cycle, and Accounting.

• Oversee the revenue cycle side of the Sliding Fee Discount Program, working with Compliance, Patient Access, Finance, and executive leadership.
• Make sure the program follows HRSA requirements, federal poverty guidelines, Center policy, and the approved discount schedule.
• Coordinate the annual update of the sliding fee schedule, including income thresholds, household size, discount levels, nominal fees, and required documents.
• Set controls so patient income, household information, eligibility decisions, approvals, effective dates, and supporting documents are accurate and complete.
• Maintain simple EHR workflows for patients to apply for, renew, and update eligibility without unnecessary barriers to care.
• Confirm sliding fee schedules are set up correctly in the EHR, practice management, and patient billing systems.

• Review contracts with the CFO and make sure billing workflows match negotiated rates and payment terms.
• Keep a central list of revenue-generating contracts, including effective and renewal dates, rates, covered services, billing and reporting requirements, payment terms, and responsible departments.

• Prepare and present monthly encounter reports and financial analyses to the CFO, covering encounter volumes, service use, revenue, and reimbursement trends.
• Compare encounter volumes to budget, forecast, prior years, and targets, and flag significant variances and trends.
• Report regularly to leadership on differences between budgeted, billed, collected, and recognized revenue.
• Calculate, record, and submit monthly secondary PPS billings to the state.
• Review revenue, billing, reimbursement, and payer mix data for accuracy and consistency with financial records and UDS requirements.
• Help reconcile UDS financial data to the general ledger, billing system, and accounts receivable.
• Help prepare quarterly reports to outside agencies, including WPHCA.

• Bachelor's degree in accounting or business administration, or at least five (5) years of progressive accounting experience.
• At least three (3) years of revenue cycle, billing, or accounting leadership experience, including supervising staff.
• At least three (3) years of experience with electronic health record (EHR) systems, including encounter reporting, visit data, billing workflows, and report generation.
• Ability to pull, analyze, and reconcile EHR data for revenue cycle operations and financial reporting.
• Experience maintaining accounting records and preparing financial reports.

• Experience with OCHIN Epic, including its reporting and data validation tools.
• Experience with MIP accounting software.
• Experience in healthcare, especially at a community health center or FQHC.
• Non-profit accounting experience, including cost accounting and preparing GAAP financial statements.
• American Indian cultural competence.

• Communication: Explain financial information clearly, both in person and in writing, to staff, leadership, and outside partners.
• Analysis and problem-solving: Gather data, draw conclusions, and recommend practical solutions.
• Accuracy and organization: Prepare accurate, well-organized reports, and plan and schedule work to meet deadlines.
• Independent judgment: Work independently, make sound decisions, and follow complex instructions.
• Relationships: Build and maintain effective working relationships with employees, officials, and the public.
• Confidentiality: Handle confidential financial and patient information appropriately.