Description:
SUMMARY
The Revenue Cycle Manager provides operational leadership and oversight for revenue cycle functions within the Tribal Health System. This position supports financial stability, regulatory compliance, optimization of third-party revenue, and alignment with Tribal values and community-centered care. The Revenue Cycle Manager oversees daily revenue cycle operations including patient access, coding, billing, PRC integration, accounts receivable management, denial prevention, and reimbursement workflows across medical, dental, behavioral health, pharmacy, and ancillary services.
PRINCIPAL ACTIVITIES & RESPONSIBILITIES:
- Manages day-to-day revenue cycle operations including Patient Registration, Scheduling, Eligibility, Patient Benefits Coordination, Coding, Billing Accounts Receivable, Denials, PRC billing integration, and Payment Posting.
- Ensures accurate patient registration, Tribal enrollment verification, insurance capture, and PRC eligibility workflows.
- Monitors encounter-rate billing (Medicaid/Medicare), fee-for-service billing, and Tribal-specific payer requirements.
- Assists with implementation and monitoring of performance dashboards, key performance indicators (KPIs), and workflow improvements.
- Ensures compliance with HIS, CMS, HIPAA, OMB, Tribal polices, and accreditation standards.
- Supports audit readiness for federal, state, and Tribal reviews.
- Monitors coding accuracy, documentation integrity, and compliance with ICD-10, CPT, HCPCS, and Tribal payer rules.
- Tracks and improves key revenue cycle metrics including clean claim rate, denial rate, days in A/R, net collection rate, and encounter closure timeliness.
- Assists with reimbursement analysis, payer mix review, and revenue forecasting.
- Collaborates with Finance regarding reconciliation processes, month-end close, and revenue reporting.
- Partners with Medical, Dental, Behavioral Health, Pharmacy, PRC, and Community Health leadership to support accurate documentation, coding, and billing practices.
- Works closely with IT and EHR support teams to optimize workflows, templates, and reporting functions.
- Leads negotiation, renewal, and amendment of all payer contract, including Medicare, Medicaid, commercial payers, CCOs, and specialty networks.
- Ensures contracts reflect Tribal sovereignty, encounter-rate rules, PRC requirements, and federal Indian Health policy.
- Maintains a centralized contract repository with version control, renewal dates, and compliance requirements.
- Coordinates internal review workflow with Finance.
- Monitors payer performance, underpayments, denials, and compliance with contract terms.
- Provides training, guidance, and support to revenue cycle staff.
- Promotes a culturally respectful and patient-centered environment aligned with tribal values.
- Maintains confidentiality of patient, employee, and Tribal information in accordance with HIPAA and Tribal policies.
- Collaborates efficiently and effectively while consistently demonstrating professionalism and maintaining positive, respectful relationships with internal teams, external partners, and Tribal members.
- Other duties as directed by management.
LEVEL OF AUTHORITY & RESTRICTIONS
- Leading a department or unit, with authority over budgets and personnel.
PHYSICAL & MENTAL DEMANDS
- Must be able to walk, talk, hear, use hands to handle, feel or operate objects, tools, or controls, and reach with hands and arms.
- Varied activities including standing, walking, reaching, bending, and lifting.
- Must be able to work on a computer to fulfill job requirements.
- Vision abilities required by this job include close vision and the ability to adjust focus.
- May be required to push, pull, lift, and/or carry up to 40 pounds.
WORKING CONDITIONS & ENVIRONMENT
- May require working occasional nights and/or weekends.
- Moderate noise level with frequent interruptions and distractions.
- Must be willing and able to travel both locally and within the CTCLUSI service delivery area.
Requirements:
MINIMUM JOB REQUIREMENTS
- Must be 21 years of age or older.
- A Bachelor's degree in Health Administration, Business, Finance, or related field; or a minimum of seven (7) years of progressively responsible experience in healthcare revenue cycle operations.
- Strong knowledge of Medicaid, Medicare, commercial insurance, and FQHC/HIS/Tribal billing environments.
- Experience with EHR/Practice Management systems such as RPMS, NextGen, Epic, Cerner, or Dentrix Enterprise preferred.
- Experience working with Tribal health systems, HIS, or FQHC settings preferred.
- Certification(s) such as CRCR, CPC, CPB, CHFP, or related credential preferred.
- Experience with PRC/CHS billing and Tribal payer rules preferred.
- Knowledge of EMR reporting structures.
- Ability to work independently and collaboratively in various work settings.
- Experience and proficiency in the use of Microsoft products (Excel, Outlook, PowerPoint, Word, etc).
- Ability to communicate clearly and effectively in English, verbally, in writing or by other acceptable means.
- This position is considered a covered role per the CTCLUSI Background Investigations Policy. A state criminal background check and fingerprint-based background check will be required as a condition of employment.
- This position is designated as safety-sensitive and is subject to pre-employment and other authorized drug and alcohol testing in accordance with company policy. Please note that the use of marijuana is prohibited for employees in this position, regardless of state legalization status.
- Must have employment eligibility in the U.S.
- Indian preference will be observed in the hiring process.