Assistant Director Revenue Cycle Optimization at Upstate Family Health Center Incorporated – Utica, New York

Upstate Family Health Care Inc. is a Federally Qualified Health Center (FQHC) offering family health care services to individuals of all ages. Clinic hours of operation are Monday - Friday.

We are committed to providing quality health care for everyone in order to build a healthier community.

Upstate Family Health Center provides a comprehensive total compensation package including competitive compensation, a generous paid time off package, a benefits package including medical, dental, vision, FSA, HRA, Life Insurance, 403(B) with lucrative company match, generous paid time off.
We are currently accepting applications for an Assistant Director Revenue Cycle Optimization position.

Job Summary:
The Assistant Director Revenue Cycle Optimization role supports the financial health of the clinic by optimizing coding, ensuring accurate charge capture, timely claims submission, efficient accounts receivable follow-up, and resolution of billing issues across all payer types. This role works closely with clinical, front desk, and administrative teams to maintain clean data, reduce denials, and support compliance with FQHC billing requirements, Medicaid/ Medicare regulations, and NY State guidelines.

The role is essential to sustaining the clinic’s mission by maximizing reimbursement and strengthening revenue cycle operations.
Certified Professional Coder for the Coding portion of the review of the claims and FQHC experience preferred.

Activities include but are not limited to the following:
• Billing and Charge Capture
o Review daily encounters for completeness, accuracy, and proper coding prior to claim submission.
o Ensure provider documentation supports billed services and meets FQHC requirements.
o Verify correct application of PPS rates, wrap‑around billing rules, and sliding fee adjustments.
o Coordinate with clinical staff to resolve missing documentation, coding discrepancies, or encounter errors.
• Claims Submission & Processing
o Prepare, scrub, and submit electronic and paper claims to Medicaid, Medicare, commercial payers, and managed care plans.
o Monitor clearinghouse rejections and correct/resubmit claims promptly.
o Maintain payer enrollment and billing credentialing information as needed.
• Accounts Receivable Management
o Conduct timely follow‑up on outstanding claims, denials, and underpayments.
o Document all follow‑up actions in the billing system and maintain accurate A/R aging reports.
o Identify trends in denials or payment delays and escalate systemic issues.
o Process patient statements, payment plans, and refunds in accordance with clinic policy.
• Revenue Cycle Optimization
o Assist in developing and maintaining workflows for registration accuracy, insurance verification, and point‑of‑service collections.
o Collaborate with front desk and clinical teams to reduce errors that impact reimbursement.
o Support month‑end close processes, including reconciliation of encounters, adjustments, and payment posting.
o Participate in internal audits to ensure compliance with HRSA, Medicaid, Medicare, and NYS billing regulations.
• Compliance and Reporting
o Maintain strict confidentiality of patient information in accordance with HIPAA and clinic policies.
o Ensure billing practices align with FQHC requirements, payer contracts, and federal/state regulations.
o Prepare routine and ad‑hoc reports on billing performance, A/R aging, denials, and productivity metrics.
o Support preparation for HRSA Operational Site Visits (OSVs) and payer audits.
UNIVERSAL DUTIES
Promote and maintain a safe working environment.
• Attend department meetings and any mandated continuing education/training programs.
• Comply with all pertinent regulatory and agency regulations and operating standards.
• Establish a work environment that creates positive communication between supervisors and employees and assimilates new employees to the organization’s culture, values and mission.
• Other duties as assigned.

Required Experience and Education:
• Associate’s degree at a minimum required
• Minimum 5 years of medical billing, accounts receivable, or revenue cycle experience; in a NY State FQHC.
• Certified Professional Coder
• ECW experience preferred, strong knowledge of Medicaid, Medicare, and commercial payer billing rules.
• Experience with CPT/HCPCS coding, ICD-10, and encounter documentation requirements.
• Proficient with Microsoft Office Suite and comfort with other billing and data systems.
• Strong analytical, organizational, and follow-up skills.
• Ability to handle confidential information with discretion.
• Ability to work independently and manage multiple priorities.

CORE COMPETENCIES
• Accuracy and attention to detail.
• Problem‑solving and persistence.
• Ability to communicate effectively with clinical and administrative staff.
• Understanding of patient‑centered, mission‑driven care.
• Ability to manage competing priorities in a fast‑paced clinic environment.

KNOWLEDGE SKILLS AND ABILITIES (KSAS) REQUIREMENTS
• Demonstrates professional, appropriate, effective, and tactful communication skills, including written, verbal and non-verbal.
• Demonstrates a positive attitude and respectful, professional customer service.
• Acknowledges patient’s rights on confidentiality issues, maintains patient confidentiality at all times, and follows HIPAA guidelines and regulations.
• Proactively acts as patient advocate, responding with empathy and respect to resolve patient and family concerns, and recognizes opportunities for improvement to meeting patient concerns.
• Proactively continues to educate self on providing quality care and improving professional skills.
• Applies and actively shares knowledge, expertise and best practices with team
• Behavior supports the mission, core values and objectives of the organization.
• Displays flexibility and openness in daily work and encourages others to stay open to change and improvement.
• Accepts and readily adapts to changing priorities, new ideas, strategies, procedures and methods.
• Demonstrates and promotes respect toward coworkers and adapts behaviors to work effectively with varying people and situations.
• Accumulates all relevant information prior to making job-related decisions.
• Presents well-considered alternatives when making recommendations.
• Makes decisions in a timely manner.
• Complies with quality assurance, OSHA, infection control, safety and other policies set forth.

WORK ENVIRONMENT
• Blood Borne Pathogen Category (OSHA) – Category III – Job related tasks do not involve exposure or potential exposure to blood, body fluids, or tissue and Category 1 tasks are not a condition of employement.

PHYSICAL DEMANDS
• The physical demands described here are representative of those that be met by and employee successfully perform the essential functions of this job and include the ability to type and operate a personal computer with various software programs, effectively operate standard office equipment, bend, stoop, crouch, kneel, twist, balance, and work at a desk for a prolonged period of time, lift and carry up to 25 pounds, and communicate (written and oral) in a clear and professional manner.
• Establish and maintain effective work relationships with co-workers and patients, maintain regular attendance, understand and carry out a variety of oral and written instructions, have knowledge of proper English usage, grammar, punctuation, spelling, and vocabulary, have the ability to learn office principles, practices, and methods, understand filing systems, including numerical, alphabetical, and chronological, learn a variety of procedures, policies, and services of the assigned work unit or program, perform assigned duties with efficiency and accuracy and maintain confidentiality.
• Certain deadlines and unanticipated developments may require work during evenings, weekends.
• Ability to quickly address any emergent issues without losing focus on task at hand.
• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising work-flow and efficiency.

Contact Group:
• Patients, clients, families, providers, physicians, employees and other community health partners.

Supervisory Responsibilities:
• All clinical staff except physicians, nurse practitioners, nurse-midwives, clinical social workers and physician assistants, podiatrists, dentists, clinical psychologists, optometrists, and chiropractors.

Upstate Family Health Center is an Equal Opportunity Employer.