Revenue Cycle Program Manager

The Revenue Cycle Program Manager oversees all operational components of the revenue cycle, including patient access, coding, billing, claims management, payment posting, denial resolution, and collections. This role ensures accurate and timely revenue capture, regulatory compliance, and alignment with Kahtnuht’ana Development Corporation (KDC)’s operational, contractual, and Tribal health obligations. The Program Manager supports all awarded proposals and contract deliverables, including Indian Health Service (IHS) and Tribal health system requirements, and provides strategic guidance to leadership on revenue optimization, compliance, and performance improvement.

PRINCIPAL ACTIVITIES & RESPONSIBILITIES

• Maintain and update payer contract records; implement contract requirements; troubleshoot reimbursement issues with payer representatives.
• Ensure payer rules are accurately reflected in charge masters, fee schedules, and Electronic Health Record (EHR) configuration.
• Implement and monitor grant funded, value based, and contract based reimbursement models across KDC operations.
• Support financial modeling and pro forma development for new IHS/Tribal contract opportunities.
• Recruit, train, mentor, and supervise revenue cycle staff; conduct performance evaluations and provide ongoing coaching.
• Establish productivity standards and quality benchmarks for registration, coding, billing, and collections teams.
• Coordinate workflows across clinical, administrative, and operational departments to ensure accurate patient intake and revenue capture. Standardize eligibility verification, documentation workflows, and encounter closure processes to reduce denials.
• Collaborate with EHR support teams across all awarded proposals and Tribal/IHS contract environments to ensure proper configuration, charge capture, and workflow optimization.
• Support testing and validation of new EHR modules, interfaces, and upgrades impacting revenue cycle.
• Provide coding and documentation guidance; oversee internal audits; implement corrective action plans and provider education. Ensure compliance with ICD 10 (International Classification of Diseases), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) coding standards.
• Develop and monitor revenue cycle Key Performance Indicators (KPI); identify performance gaps and implement improvement strategies.
• Track clean claim rate, denial rate, days in Accounts Receivable (AR), and encounter closure timeliness.
• Prepare monthly wrap submissions, quarterly reconciliations, and appeals for Prospective Payment System (PPS), All-Inclusive Rate (AIR), and other federal/state reimbursement programs.
• Manage Alternative Payment Model (APM) enrollment, reconciliation, and appeals.
• Monitor quality and utilization metrics tied to APM participation and support corrective action plans.
• Oversee claims processing, payment posting, denial management, AR follow up, credentialing workflows, and patient collections. Support credentialing and enrollment activities; troubleshoot credentialing related denials.
• Maintain provider enrollment records, effective dates, and payer-specific credentialing requirements.
• Collaborate with Finance to forecast encounter volumes, net revenue, and AR trends.
• Provide revenue cycle input into budgeting, cash flow projections, and contract performance reporting.
• Maintain and update fee schedules; coordinate with EHR support teams to ensure alignment across systems.
• Monitor impacts of fee schedule updates on reimbursement and patient responsibility.
• Develop and update policies and procedures related to revenue cycle operations.
• Support compliance with Federally Qualified Health Center (FQHC), Health Resources and Services Administration (HRSA), IHS, 340B, Vaccines for Children (VFC), and other regulatory programs.
• Ensure compliance with Centers for Medicare & Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), Health Insurance Portability and Accountability Act (HIPAA), and the False Claims Act.
• Provide revenue cycle expertise for proposals, Statements of Work (SOWs), and contract modifications.
• Translate contract requirements into operational workflows, reporting structures, and performance metrics.
• Support transition planning, onboarding, and implementation for new IHS/Tribal contract awards.
• Perform additional duties as assigned.
• Travel up to 40%.