The Petaluma Health Center’s mission is to provide high quality health care, with access for all, in Southern Sonoma County. The Center accomplishes this mission through collaborative, innovative programs, services and referral resources that meet the economic needs of the entire community.
The Petaluma Health Center is an eight-time award winner in the North Bay Business Journal’s Best Places to Work for 2017, 2016, 2015, 2014, 2013, 2012, 2011 and 2009 and we were named as one of '2015 Healthiest Companies in the North Bay' by the North Bay Business Journal.
We are a Federally Qualified Health Center (FQHC) that provides primary medical care and mental health services to residents of Petaluma, Rohnert Park, Cotati, Penngrove and surrounding areas. We are organized as a private, non-profit corporation and governed by a consumer and community led Board of Directors.
For more information about us, please visit us at www.phealthcenter.org.
Position Title: Director, Revenue Cycle Management
Summary: The Director, Revenue Cycle Management will direct a continually improving robust, patient revenue cycle management system, in a nationally-recognized, award winning, multi-site Federally Qualified Health Center serving almost 40,000 patients, with 200,000 encounters and annual patient revenue of $40M. Under the direction of the CFO, the Director, Revenue Cycle Management will assist in enhancing and improving revenue yield, year over year. The Director is responsible for promoting financial viability of Petaluma Health Center (PHC) by effectively managing all aspects of the organization’s revenue cycle operations. You will lead organization-wide patient-friendly workflows and processes throughout the revenue cycle that maximize revenue, contribute to efficiency and productivity, and support regulatory compliance. You will lead and continually develop an accountable and service-oriented revenue cycle team that is aligned in shared goals, outcomes, and mission. You will champion optimization, measurement, and efficiency, and ensure revenue cycle operations are performance-driven, data informed, and structured to meet strategic objectives within established budgets and timeframes.
Areas of Responsibilities:
Develop Revenue Cycle Policies, Procedures and Systems:
- Develop and operationalize accurate, well documented, timely and compliant revenue cycle policies, procedures and systems in all applicable areas that maximize revenue and prevent errors, including: patient registration, authorization, eligibility, benefits verification; charge entry; coding; claim submission and management; accounts receivable management, including but not limited to: denials, bad debt and collections, appeals processing and payment posting, credit balance resolution
- Provide oversight to all billing staff, hire billing staff and ensure that staff have all necessary competencies; provide staff with clear and effective training to improve performance, as needed; hold staff accountable to clear and measurable productivity and accuracy metrics; develops and implements systems and business controls to monitor staff compliance; ensures staff are operating under all applicable standards and directs and supervises the daily activities and workflows of registration and financial counseling staff to ensure that work areas are staffed appropriately, breaks are taken and overtime is utilized appropriately
Center-wide Communications and Training:
- Cultivate and build effective relationships across the organization to optimize Patient Revenue Cycle
- In collaboration with the COO and Front Office leadership, ensure optimal function of front-end revenue cycle elements, including patient registration, documentation, and upfront patient collections
- Communicate changes in revenue cycle requirements, regulations, and reimbursement
- Educate staff across the organization on how their functions impact the organization’s revenue cycle, including its bad debt, cash flow, and accounts receivable, as well as customer loyalty and the overall financial health of PHC
- Report key revenue metrics monthly, and explain incidents and/or trends immediately to all team members and all levels of management as appropriate
Timeliness & Denials:
- Take timely and urgent action when any expected payment is not received as expected.
- Implement systems to prevent untimely payments/receipts and denials and develop and implement action plans to address issues as needed
- Monitor, respond to, and communicate changes in revenue cycle requirements, regulations, and reimbursement
- Ensure compliance with federal and state laws, specifically pertaining to revenue cycle by analyzing internal policies, and implementing appropriate charges
- Analyze, understand and negotiate excellent third party contracts in terms of cost, volume and reimbursement rates
- Maintain expertise on Medi-Cal, Medicare, and all CMS rules, regulations and processes for FQHCs in California
- In collaboration with the CFM, manage any third-party or consultant agreements needed to supplement the functions of the internal revenue cycle office
- Ensure optimal configurations that ensure accurate billing and coding are maintained for all revenue cycle applications, including but not limited to Electronic Medical and Dental Records, Practice Management, and Clearinghouses
- Ensure compliance with federal, state, and HIPAA privacy and security regulations as well as with terms of payer contracts and other federal and state programs including Medi-Cal, FPACT, and 340B
- Lead the revenue cycle compliance program including coordinating and overseeing external billing audits, designing action plans, and implementing process improvements