Revenue Cycle Supervisor, Credentialing & FQHC Billing
Overview
Supervise daily revenue cycle and provider credentialing operations at an FQHC, ensuring accurate billing, timely payer enrollment, and compliance with HRSA and NCQA standards. Lead a team of revenue cycle and credentialing staff across Medical, Dental, and Behavioral Health service lines. Manage billing, collections, denial trends, Medicaid WRAP activity, and LOA billing processes. Optimize workflows within Athena and Dentrix EMR platforms. This role offers direct impact on reimbursement integrity and operational efficiency.
What You'll Do9
- 1Lead daily revenue cycle and credentialing operations, monitoring billing accuracy, denial trends, and reimbursement performance for Medical, Dental, and Behavioral Health.
- 2Oversee provider credentialing and re-credentialing, including NCQA compliance, primary source verifications, and payer enrollment timelines.
- 3Monitor Medicaid WRAP activity, LOA billing workflows, and payer reimbursement discrepancies to ensure timely and accurate claims.
- 4Reconcile patient demographic and insurance data between Dentrix and Athena to maintain data integrity and claim accuracy.
- 5Coordinate with Patient Access, Finance, and IT to resolve registration and billing issues, improving clean claim rates and reducing denials.
- 6Conduct routine audits of credentialing files and revenue cycle processes, ensuring compliance with HIPAA, CPT, and ICD-10 standards.
- 7Prepare and present credentialing status reports and audit findings to leadership, supporting data-driven decisions.
- 8Collaborate cross-functionally to identify workflow gaps and implement process improvements, optimizing reimbursement turnaround times.
- 9Assist in onboarding and training new staff on FQHC billing, coding, and credentialing requirements.
Requirements9
- 15-7 years of healthcare billing experience in a primary care setting, with 3-5 years in provider credentialing or enrollment.
- 23+ years of supervisory or leadership experience in a revenue cycle or credentialing environment.
- 34-5 years of experience in an FQHC or similar healthcare setting preferred.
- 4Proficiency with Athena EHR system, and experience with Dentrix preferred.
- 5Certified Professional Coder (CPC) certification preferred.
- 6Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Manager (CPMSM) preferred.
- 7Bachelor's degree preferred, with strong knowledge of Medicare, Medicaid, managed care, and commercial insurance billing.
- 8Strong understanding of CPT and ICD-10 coding principles and HRSA compliance requirements.
- 9Proficiency in Microsoft Excel and Word for reporting and data analysis.
Salary Insight
$65 - $94k per year
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