Revenue Cycle Manager at ZUFALL HEALTH CENTER INC – Dover, New Jersey

Reporting to the Chief Financial Officer, the Revenue Cycle Manager is responsible for the strategic oversight and day-to-day management of all revenue cycle operations for a Federally Qualified Health Center (FQHC) generating approximately $26 million in annual patient revenue. This role ensures optimal financial performance through effective management of billing, collections, reimbursement, front-end revenue processes, and compliance with federal, state, and payer regulations specific to FQHC Prospective Payment System (PPS) reimbursement. The Revenue Cycle Manager leads revenue integrity initiatives, drives performance improvement, strengthens internal controls, and ensures timely and accurate reimbursement from Medicaid, Medicare, managed care organizations, commercial payers, and self-pay patients.

Essential Functions, Duties and Responsibilities

Revenue Cycle Oversight

• Direct and oversee all components of the revenue cycle, including:
• Patient registration and eligibility verification
• Sliding Fee Scale application and compliance
• Charge capture and coding
• Claims submission
• Payment posting
• Accounts receivable (A/R) management
• Denials management and appeals
• Patient collections
• Ensure accurate FQHC PPS and wrap-around billing.
• Monitor charge lag, claim lag, denial rates, and A/R days.

Financial Performance & Metrics

• Develop and monitor KPIs, including:
• Days in A/R (target: less than 40 to 45 days, typical for FQHC) Net collection rate (greater than 95%)
• Denial rate (less than 5 to 7%)
• Clean claim rate (greater than 95%)
• Prepare and present monthly revenue cycle performance reports to CFO and executive leadership.
• Analyze payer mix and reimbursement trends.
• Identify revenue leakage and implement corrective action plans.

FQHC Compliance & Regulatory Oversight

• Ensure compliance with:
• HRSA regulations
• UDS reporting requirements
• Medicaid and Medicare FQHC billing rules
• Sliding Fee Discount Program (SFDP) regulations
• 340B-related billing considerations
• Maintain knowledge of PPS rate changes, wrap payments, and cost report implications.
• Collaborate with finance team during annual cost report preparation and audits.

Team Leadership & Development

• Supervise billing, coding, A/R, and patient financial services staff.
• Establish productivity benchmarks for billing and collections teams.
• Conduct regular staff training on coding updates, payer rules, and compliance.
• Foster a culture of accountability, customer service, and continuous improvement.
• Participate in hiring, performance evaluations, and corrective action processes.

Denials & A/R Management

• Implement structured denial management workflows.
• Conduct root cause analysis of recurring denials.
• Oversee timely appeals submission.
• Ensure aged A/R follow-up protocols are consistently executed.
• Manage high-dollar account resolution.

Process Improvement & Systems Optimization

• Partner with IT and EHR vendors to optimize billing workflows.
• Improve automation in claims scrubbing and eligibility verification.
• Develop internal controls to minimize billing errors.
• Lead revenue cycle improvement initiatives.
• Participate in implementation of new payer contracts or service lines.

Cross-Department Collaboration

• Work closely with:
• Clinical leadership to improve documentation accuracy
• Front desk staff to strengthen front-end collections
• Finance department for reconciliation and reporting
• Educate providers on documentation requirements that impact reimbursement.

Supervisory Responsibilities

• Direct supervision of billing and revenue cycle staff (typically 5–12 FTEs depending on size).
• Indirect oversight of front-end revenue processes.

Knowledge, Skills and Abilities

• Strong analytical and financial acumen
• Knowledge of PPS reimbursement methodology
• Regulatory compliance expertise
• Leadership and team development skills
• Process improvement orientation
• Advanced Excel and revenue analytics capability
• Experience with eClinicalWorks

Education, Training and Experience

• Bachelor’s degree in Healthcare Administration, Finance, Business, or related field required.
• Master’s degree preferred.
• 5+ years of healthcare revenue cycle experience.
• Minimum 2–3 years in a supervisory or management role.
• FQHC experience strongly preferred.
• Strong understanding of Medicaid and Medicare FQHC billing rules.

Certifications

• HFMA (CRCR or CHFP)
• CPC or CPB
• FQHC-specific revenue training

Work Environment

• On-site role.
• Fast-paced healthcare environment with multiple payer sources.