Director of Revenue Cycle Management

About FCHC:

Since 1976, Florida Community Health Centers, Inc. (FCHC) has been a health care leader in Florida. We provide comprehensive primary and specialty health care and patient support services through a network of Centers surrounding Lake Okeechobee and across Florida’s Treasure Coast. Our mission is to ensure that everyone in our communities has access to culturally competent, high-quality health care that they can afford. FCHC has locations in Clewiston, Moore Haven, Okeechobee, Fort Pierce, Port St. Lucie, Stuart, Indiantown, Pahokee and West Palm Beach. FCHC’s Corporate Office is centrally located in West Palm Beach, Florida. FCHC has multiple staff members who speak Spanish and Creole, and translation is available for other languages as needed. FCHC has created a “one-stop shop” for patients–providing Pediatric and Adult Primary Care, Dental, OB/GYN and Women’s Health, Infectious Disease, Behavioral Health, Pharmacy, chronic disease education and care management, referral assistance, benefit enrollment assistance and coordination, and telehealth services. Our patients benefit from a “medical home” model, where they may access our extensive array of health care clinicians and services in an atmosphere where they are treated with respect, care, and concern.

Mission

The Mission of Florida Community Health Centers, Inc. (FCHC) is to provide accessible, cost-effective, high-quality, comprehensive health care to all persons in our communities.

Vision

Florida Community Health Centers, Inc. (FCHC) will maintain strong leadership in, and advocate for, the provision of health care services.

FCHC will foster and promote collaborative relationships and will develop partnerships with local, state, and federal public health service agencies and the community in general, to enhance the quality of delivery systems for comprehensive health care. FCHC will be an employer of choice and will demonstrate excellence with a highly trained staff and governing board.

Values

FCHC values Integrity, Compassion, Commitment to serving others (external and internal to the organization), Innovation, Effectiveness (cost and outcome), Efficiency, being Mission-driven, Commitment to serving others internal to organization and Commitment to Excellence.

Position Summary: The Director of Revenue Cycle Management is an exempt, management position responsible for directing activities related to patient service revenue to ensure maximization of cash flow while improving patient, physician, and other customer relations.

Roles and Responsibilities:

• Establish relationships with and maintain regular meetings with FCHC’s major payors.
• Track payor contract terms and annual renewal dates; negotiate annual fee increases
• Obtain or build payor specific fee schedules, ensure they are loaded and appropriately maintained in Epic
• Collaborates with senior leadership on any risk-based contract proposals
• Collaborates with the Director of Operations and Training to ensure the centers are advised when FCHC contracts with new plans
• Collaborates with the CMO on ensuring all billing supervisory relationships are current in Epic.
• Oversee all updates and changes to FCHC’s chargemaster ensuring adequate financial recovery from charges to self-pay patients and where CLIA tests require testing equipment that they align to the appropriate centers
• Monitor all CMS Guidance applicable to FQHC billing and advise leadership on new or emerging billing opportunities
• Perform billing and reimbursement research for new services
• Design and execute organizational training curriculum on billing standards; collaborate with training department on
• Manage all payor appeal activities, report on progress on a periodic basis
• Collaborate with the Credentialing Supervisor on understanding the impact of clinician changes on payor credentialing and linkages. Ensure communication on clinician changes is disseminated to the Director of Operations
• Collaborate with the HIS Manager on Availity (Clearinghouse) Administration
• Provide guidance to centers on optimal usage of clearinghouse resources
• Along with the Director of Finance, Controller, monitor the performance of cash postings in Epic relative to EFT/EOM matching in Availity, ensuring cash postings and payor AR balances are properly stated
• Collaborate with the Director of Finance, Controller, on month-end review and adjustments to payor AR reserves, Medicaid/Medicare wrap & LIP forecasts
• Oversees FCHC performance under “special contracts” ensuring transactions are posted correctly in Epic and month-end (manual) invoicing is performed accurately and timely
• Monitor and report on registration, charge and claim Epic work queues
• Establish relationships with and maintain regular meetings with HCN Epic RCM staff, develop and track rules for holding, writing-off and adjusting charges in Epic
• Support Director of Operations in understanding RCM trends by center and in establishing appropriate monitoring strategies
• Establish and maintain standard RCM reporting package
• Develop and execute periodic claims audits to validate compliance with federal and state billing standards
• Develop and execute periodic claims and orders audits to validate labs are routed to the correct Reference Laboratory
• Collaborates with the Director of Finance, Controller on the development of FCHC’s annual UDS Table 9
• Able to communicate verbally and in writing effectively with outside partners, managers, supervisors, peers, and subordinates.
• Other duties as assigned

Qualifications and Education Requirements

Minimum Requirements (experience, training, and education): To effectively fulfill this position, candidate must meet the following requirements:

• Bachelor of Science or Bachelor of Arts degree in applicable course work and applicable work experience. Master’s Level degree preferred.
• Minimum of four years experience with a working knowledge of computer systems. (Two of these four years should be in healthcare.)
• CPC helpful but not required.
• Must demonstrate advanced working knowledge of Microsoft Excel and be able to teach others.

This job description is not intended to be all-inclusive, and employee will also perform other reasonable related business duties as assigned by supervisor.

* This organization reserves the right to revise or change job duties and responsibilities as the need arises. This job description does not constitute a written or implied contract of employment*.