Plexus Health is hiring an experienced Revenue Cycle Manager to join our team. Excellent benefits, competitive pay, and a collaborative team.
Revenue Cycle Operations
· Manage the end-to-end revenue cycle process from patient registration through final payment collection.
· Oversee insurance verification, eligibility determination, prior authorizations, charge entry, coding, claims submission, payment posting, and collections.
· Monitor daily, weekly, and monthly revenue cycle activities to ensure timely reimbursement.
· Develop and implement workflows that improve revenue cycle efficiency and reduce denials.
· Ensure proper application of billing requirements, including Prospective Payment System (PPS) and applicable encounter billing guidelines.
Accounts Receivable & Collections
· Monitor accounts receivable aging and establish performance goals for collection efforts.
· Analyze and resolve outstanding claims, denials, underpayments, and payment discrepancies.
· Develop action plans to reduce days in A/R and improve cash collections.
· Oversee patient payment plans and collection processes while maintaining a patient-centered approach.
Billing & Coding Compliance
· Ensure compliance with Medicare, Medicaid, HRSA, UDS reporting requirements, and commercial payer regulations.
· Collaborate with coding staff and providers to promote accurate documentation and coding practices.
· Conduct periodic audits of billing and coding processes to identify risks and opportunities for improvement.
· Stay current on regulatory changes affecting FQHC reimbursement and billing practices.
Payer Credentialing & Enrollment
· Oversee provider payer enrollment, revalidation, and credentialing processes to support timely billing and reimbursement.
· Maintain accurate provider enrollment records and monitor credentialing timelines, expirations, payer approvals, and required updates.
· Coordinate with providers, leadership, payers, clearinghouses, and external credentialing resources to resolve enrollment issues and reimbursement delays.
· Ensure payer credentialing activities comply with Medicare, Medicaid, HRSA, commercial payer, and organizational requirements.
Financial Performance & Reporting
· Prepare and analyze revenue cycle reports.
· Present revenue cycle performance metrics and recommendations to leadership.
· Assist with budgeting, forecasting, and revenue projections.
Leadership & Staff Development
· Supervise and develop revenue cycle staff, including billing specialists, coders, payment posters, and patient financial services personnel.
· Establish performance expectations and provide ongoing coaching and training.
· Foster a culture of accountability, customer service, and continuous improvement.
· Participate in recruitment, onboarding, and performance management activities.
· Systems & Process Improvement
· Serve as a subject matter expert for practice management, electronic health record (EHR), and billing systems.
· Identify opportunities to automate processes and improve workflow efficiency.
· Partner with clinical and operational leaders to improve documentation, charge capture, and reimbursement outcomes.
· Manage outsourced vendor billing and coding partners, if applicable. Ensure compliance and service-level agreements are maintained.
Perform other duties as assigned.
Requirements and Skills:
· Associate’s degree in a related field plus five years of relevant experience, or equivalent combination of education and experience.
· Proficient with MS Office, revenue cycle software systems, and EMR/ERH systems.
· Knowledge of HRSA compliance standards and Uniform Data System (UDS) reporting preferred.
· Prior experience in an FQHC community health care center, rural healthcare clinic, or other similar environment preferred.
· Certified Professional Coder (CPC), Certified Revenue Cycle Representative (CRCR), Certified Healthcare Financial Professional (CHFP), or other relevant healthcare revenue cycle certification strongly preferred.
· Experience with provider credentialing, payer enrollment, revalidation, and payer portal processes preferred.
· Strong mathematical, organizational, and analytical skills.
· Ability to successfully complete a pre-employment background check and drug screen.
Pay: $75,000.00 - $90,000.00 per year
Work Location: In person
