Petaluma Health Center · 19 hours ago
Director of Revenue Cycle Management
Petaluma, CA
Full-time
Onsite
Director/Executive
7+ years expPetaluma Health Center's mission is to provide high quality health care with access for all in Southern Sonoma County & West Marin. The Director of Revenue Cycle Management provides strategic and operational leadership for all revenue cycle and payor enrollment functions, ensuring accurate, timely, and compliant reimbursement across all payor sources while leading high-performing teams.
DentalHealth CareMedical
Responsibilities
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
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
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
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
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
Qualification
Required
Bachelor's degree in business, Finance, Accounting, Health Management or related field, or equivalent experience required
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
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
Preferred
Master's degree (MBA or MHA) 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
Bilingual in English and Spanish, both written and verbal preferred
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)
Company
Petaluma Health Center
Petaluma Health Center provides patient-centered medical, dental and specialty healthcare services for the communities.
501-1000 employees
Funding
Current Stage
Late StageTotal Funding
$0.02MKey Investors
Healthy Petaluma
2024-02-13Grant· $0.02M
Leadership Team
Pedro Toledo
Chief Executive Officer
Recent News
The North Bay Business Journal
2024-05-24
The North Bay Business Journal
2024-03-13
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