Job Description

Essential Responsibilities:

Revenue Cycle Operations Management

Direct, supervise, and evaluate billing and revenue cycle staff and vendor relationship with BetterHealth, assigning and monitoring work duties and deliverables under the contract such as patient account management, insurance verification and eligibility, claims submission and follow-up, payment posting and reconciliation, collections and account resolution, contractual adjustment analysis, and policies and procedures.

Serve as the affiliate’s primary Epic revenue cycle subject matter expert and system owner, with hands-on working knowledge of Epic Resolute Professional Billing that includes charge description master (CDM) maintenance, schedule of discounts, claim edits, work queues, and payer rules.

Partner with BetterHealth analysts and PPM analysts to identify and implement system enhancements, Epic upgrades, and workflow improvements that increase efficiency, accuracy, and compliance.

Coordinate revenue cycle processes for all reproductive health service lines including contraception, abortion services, STI testing and treatment, prenatal care, and gender-affirming care as applicable

Financial Performance and Analytics

Develop and maintain Epic-based reporting and dashboards to monitor key revenue cycle metrics including AR days, denial rates, clean claim rates, collections performance, and payer-specific trends

Prepare and present monthly revenue cycle performance reviews with vendor leadership and present to executive leadership

Identify root causes of revenue leakage, underpayment, and denial trends and develop and execute action plans for measurable, sustained improvement

Coding Compliance and Education

Oversee Epic training content and competency for revenue cycle staff and clinical front-end users; coordinate with the training team to ensure consistent system utilization and documentation practices

Act as the primary liaison between the billing vendor and internal departments ensuring clear communication, identification of trends, issue resolution, and continuous workflow improvement

Collaborate with Health Center Managers and Medical Services leadership to optimize front-end revenue cycle processes including patient registration, insurance verification, eligibility checking, sliding fee scale application, and point-of-service collections

Create tools, training materials, and job aids to support clinical and front-desk staff in efficient, compliant revenue cycle practices

Oversee coding and billing audits to ensure compliance and revenue integrity

Provide oversight and training to front desk and registration staff, ensuring accurate patient registration to minimize downstream billing errors

Auditing Compliance and Grants Support

Ensure all billing activities comply with federal and state regulations, HIPAA privacy and security requirements, payer contract terms, and Planned Parenthood’s organizational standards and mission

Oversee and audit outsourced billing to ensure accuracy, contract compliance, and performance against defined service level agreements

Collaboratively review the coding audits with operations and IT analysts to identify training and system enhancements to improve compliant billing and coding.

Ensure the billing vendor maintains compliance with HIPAA Business Associate Agreement (BAA) requirements and PPM’s data security and privacy policies; participate in vendor compliance audits as needed

Support billing and documentation requirements for the Title X Family Planning Program, including sliding fee scale compliance, service coding, and federal reporting obligations

Payer Relations and Contract Management Support

Direct third-party payer contract negotiations, management, and payer relations, including MCO contracts, fee schedule reviews, and dispute resolution.

Manage the billing company contract lifecycle: participate in vendor selection and RFP processes, negotiate contract terms and service level agreements (SLAs), monitor performance against SLAs, and escalate or remediate as needed

Ensure the billing company receives complete, accurate, and timely data from Epic and internal operations to support clean claim submission; identify and resolve data or workflow gaps that impact vendor performance

Maintain deep, current knowledge of state Medicaid programs, Medicaid managed care organization (MCO) billing requirements, and fee-for-service rules.

Monitor third party credentialing and enrollment activities to ensure all providers are enrolled and revalidated with all applicable payers on a current basis and oversee prior authorization process

Review and approve billing company invoices; track vendor costs against budget and evaluate cost-effectiveness of outsourced functions versus in-house capabilities on an ongoing basis

Staff Leadership and Development

Recruit, onboard, develop, and retain a high-performing revenue cycle team; set clear performance expectations and conduct regular performance evaluations

Foster a culture of accountability, continuous improvement, and mission alignment within the revenue cycle function

Champion diversity, equity, inclusion, and belonging in all hiring, team management, and cross-departmental relationships

Ensure all staff complete required annual compliance, HIPAA, and organizational training

Perform other duties as assigned by the Chief Financial Officer

This role is hybrid in nature and the remote work schedule is subject to the needs of the organization and direction and approval of the supervising manager.

Employment Standards:

Education/Experience:

Bachelor’s degree in Accounting, Finance, Healthcare Administration, Business, or a related field preferred

Minimum of three (3) years in a leadership or director-level role

Minimum of two (2) years of direct, hands-on experience with Epic Resolute Professional Billing required.

Experience in reproductive health, family planning, community health center (FQHC), or women’s health settings strongly preferred

Professional certification preferred: CPC (Certified Professional Coder), CRCR (Certified Revenue Cycle Representative), CHBME, or FHFMA

Knowledge, Skills and Abilities:

Epic & Technology

Expert-level working knowledge of Epic Resolute Professional Billing, including claim submission, work queue management, ERA/EOB processing, RTE, and reporting tools

Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data modeling)

Familiarity with clearinghouse platforms (e.g., Availity, Change Healthcare/Optum) and electronic claim submission processes

Coding & Compliance

Thorough knowledge of CPT, ICD-10-CM/PCS, and HCPCS Level II coding, with specific familiarity with reproductive health service coding including contraceptive management, family planning, and abortion services

Strong understanding of federal and state Medicaid programs, Medicaid MCO billing requirements, and managed care contract structures

Knowledge of Title X program billing requirements, sliding fee scale regulations, and federal family planning service documentation standards

Familiarity with HIPAA privacy and security regulations and their application to billing, data sharing, and vendor management

Understanding of value-based payment models and quality-based incentive structures as they affect revenue cycle operations

Leadership & Communication

Proven ability to lead, develop, and motivate a diverse team in a multi-site, mission-driven healthcare environment

Excellent analytical, strategic, and problem-solving skills; ability to translate complex data into clear, actionable insights for executive and clinical audiences

Strong oral and written communication skills; able to present ideas convincingly and concisely to both technical and non-technical stakeholders

Strong commitment to reproductive health equity, patient-centered care, and Planned Parenthood’s mission and values

Well organized with demonstrated ability to manage competing priorities, set timelines, and drive results

Ability and willingness to travel to affiliate health center locations as needed

Physical Demand:Ability to lift 25 pounds for the occasional need. Ability to stand or sit for prolonged periods of time. Ability to use computer screen for prolonged periods of time.

Mental Demand:Must be able to function efficiently in a fast paced environment despite distractions and interruptions.

Confidentiality: Must follow all Federal, state and Planned Parenthood health data protection requirements (including HIPAA). May be exposed to confidential information whose disclosure would be contrary to the best interest of the agency, the patient, facility and professional ethics.

Work With Others: Has contact with employees, patients and outside agencies, furnishing and obtaining information. Requires a cooperative and courteous attitude, as well as excellent phone and communication skills.

Benefits:

• Medical, Dental, and Vision insurance.
• Flexible Spending Account.
• Life, AD&D Insurance.
• Short-Term and Long-Term Disability.
• Paid Time Off (PTO) and Paid Holidays.
• Employee Assistance Program.
• 401(k) Retirement Plan.