Vice President Operational Risk Jobs in Chicopee, MA

General Description:

The Vice President (VP) of Revenue Cycle is responsible for the strategic oversight and operational performance of revenue cycle functions. This role plays a key part in ensuring financial sustainability by maximizing reimbursements, improving cash flow across all clinical and pharmacy service lines, strengthening payer relationships, and ensuring full compliance with FQHC-specific billing regulations. This role is also responsible for effective payer contract negotiation, and the development and oversight of AR and financial performance through reporting, data analysis, and key metrics.

Reporting to the Chief Financial Officer (CFO), the VP collaborates closely with finance, clinical, operations, billing, compliance, pharmacy, and credentialing teams to drive operational excellence and mitigate risk across all service lines, including medical, dental, behavioral health, and pharmacy (retail and 340B).

While this position does not have direct supervisory oversight of the Billing team, it holds a dotted-line relationship and works in close partnership to ensure billing functions are fully aligned with financial performance objectives, payer requirements, and FQHC best practices.

Minimum Requirements:

• Associate’s degree required; Equivalent experience considered.
• Certified coder (CPC, CCS, or equivalent) strongly preferred.
• Minimum of 10 years in revenue cycle leadership, with FQHC or community health center.
• Deep knowledge of FQHC billing regulations and payer requirements (MassHealth, HSN, Medicare, Medicaid/Medicare ACO’s, PPS, wrap payments, capitation, etc.).
• Proven experience with pharmacy billing, 340B revenue management, and retail pharmacy revenue cycle workflows.
• Expertise in medical, dental, and behavioral health revenue cycle management.
• Extensive knowledge of revenue cycle management, including billing, coding, collections, reporting and analysis.
• Expertise with state systems (e.g., MMIS) and electronic health record platforms (e.g., eClinicalWorks, NextGen, Athena, Epic).
• Proven ability and success in managing and negotiating payer relations and contracting.
• Strong analytic skills with advanced Excel capability and data reporting tools.
• Demonstrated ability to influence cross-functional teams without direct authority.
• Excellent communication, leadership, and problem-solving skills.
• High attention to detail, integrity, and commitment to the organization’s mission.

Key Competencies:

• FQHC Reimbursement Strategy & Compliance
• Revenue Cycle Analytics, Reporting & Performance Metrics
• MassHealth, HSN, Medicare, Medicaid, and Commercial Payer Expertise
• Pharmacy Revenue Cycle (Retail & 340B) Oversight
• Contracting, Capitation, and Wrap Payment Management
• Cross-Functional Collaboration & Process Improvement
• Credentialing Coordination & Denial Mitigation

Principal Responsibilities and Duties:

Payer Contracting & Reimbursement Strategy

• Review and support negotiation of third-party payer contracts, including commercial payers, Medicare Advantage, and Medicaid Managed Care plans.
• Analyze reimbursement terms, payment methodologies, and ensure alignment with FQHC reimbursement models (PPS, wrap payments, APMs).
• Track and report on payer performance trends; identify opportunities for enhanced reimbursement.
• Serve as a subject matter expert on FQHC-specific reimbursement rules, including MassHealth, HSN, Medicare PPS, Medicaid ACOs, and state-specific billing regulations.
• Review and validate quarterly MassHealth wrap payments and monthly capitation payments; report discrepancies and trends to CFO.
• Monitor payer policy changes and FQHC reimbursement guidance to ensure organizational readiness.

Revenue Cycle Oversight

• Develop and implement strategies to optimize revenue, reduce days in AR, and improve net collections.
• Lead process improvements that enhance billing accuracy and operational efficiencies across medical, dental, behavioral health and pharmacy departments.
• Lead root-cause analysis of denials and write-offs; present recommendations to reduce preventable rejections and payment delays.
• Oversee AR aging review processes to ensure timely resolution by payer type and self-pay category.
• Develop dashboards and conduct detailed KPI reporting (charges, payments, adjustments, denials, encounter closure).
• Ensure annual review and update of organizational fee schedules in collaboration with the CFO and Billing Director.

Pharmacy (Retail & 340B) Revenue Cycle

• Monitor and optimize pharmacy revenue workflows and payment posting processes.
• Lead analysis and reconciliation of 340B and retail pharmacy AR, reserves, and payment accuracy.
• Provide monthly pharmacy revenue cycle reporting with detailed performance and reserve analysis.
• Oversee monthly revenue cycle reporting package, including detailed analysis

Internal Audit, Compliance & Reporting

• Coordinate external coding audits and conduct internal audits to ensure compliance with payer-specific and billing regulations.
• Support audit readiness for HRSA OSV, financial audits, and payer reviews.
• Assist with the preparation of UDS reports, Medicare/Medicaid cost reports, and other regulatory filings.
• Lead reporting and analysis of KPIs, collection rates, and net revenue performance.

Collaboration & Departmental Leadership

• Partner with the Billing Director and team to improve billing workflows, resolve escalations, and implement best practices.
• Identify and implement automation opportunities for posting, reconciliation, denial tracking, and reporting.
• Deliver staff development support, including Excel and data tool training, to increase operational efficiency.
• Collaborate with medical, dental, behavioral health, and pharmacy departments to address incomplete or open visits and improve charge readiness.
• Facilitate cross-departmental meetings focused on revenue cycle strategy, compliance, and clinical integration.
• Mentor and support billing and operational teams, fostering a high-performance, mission-driven culture with a focus on customer service excellence and accountability.
• Develop educational resources and provide training to operational/clinical leaders on their role/impact on revenue cycle.
• Research new service lines as to potential reimbursements

Credentialing Support & Vendor Relations

• Work with internal credentialing staff and external vendors to ensure timely provider enrollment, revalidation, and updates across all payers.
• Monitor credentialing-related denials and assist in tracking, resolving, and preventing claims rejections due to enrollment issues.
• Develop centralized tracking systems and communication pathways to proactively manage credentialing-related revenue risks.

Ad Hoc & Strategic Reporting

• Respond to leadership requests for financial, operational, and payer performance reports.
• Assist the CFO in developing reimbursement projections, financial models, and data for strategic initiatives, grants, or capital projects.
• Continually assess technology and automation tools to enhance revenue cycle processes and system efficiency.

Working Conditions

• Position requires prolonged periods of sitting at a desk and typing on a computer; ability to stand for prolonged periods of time; ability to perform moderate activities such as climbing stairs, bending, stooping, reaching, and lifting up to 20 pounds at times.

Salary Range: 105,000- $150,000