Director, Billing and Accounts Receivable (Administrative)

Title: Director, Billing and Accounts Receivable
Reports to: VP, Credentialing and Billing
Classification: Director
Location: Boston (Hybrid)
Job description revision number and date: V2.0; 4.24.25

OrganizationSummary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit, Accountable Care Organization (ACO) governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We are a fast-growing organization founded in 2016 and now serving hundreds of thousands of beneficiaries who receive primary care at health centers and independent practices in Massachusetts and across the country. We are an innovative organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary:
This position provides leadership and oversight to the billing and accounts receivable activities for our FQHCs that are on our instance of Epic and/or in our Share Services model. The ideal candidate will lead and manage a team of billing and operational resources, ensuring compliance with state and federal guidelines, optimize accounts receivable performance, and provide strategic support to both C3 and our FQHCs financial goals. The position collaborates with the Revenue Integrity Director and Credentialing Manager particularly around claim form logic, denial management, and optimal Epic workflow and reporting. The Director of Billing and Accounts Receivable should have a background in FQHC billing requirements, proficiency in using Epic, and a solid understanding of healthcare billing regulations, particularly in Massachusetts.

Responsibilities:
Supervises and mentors the billing team, providing training and support to maintain high standards of accuracy and productivity
Helps create the vision for the C3 to be the go-to resource for an affordable and efficient MSO in Billing and Credentialing
Facilitates positive collaboration with other leaders within the MSO, across C3, and at the Health Centers
Conduct regular performance reviews and address performance issues promptly
Foster a collaborative and professional team environment
Remains current on billing codes, payer requirements, and policy changes
Establishes, updates, and maintains policies and procedures governing billing and collections, ensuring the documentation is always current, complete, and user-friendly

Identifies process and technology improvements to improve the effectiveness and efficiency of revenue cycle operations. Collaborates with internal and external constituents to execute improvements
Oversees all AR including insurance and self pay
Oversees daily billing operations for the FQHC(s), ensuring accurate and timely processing of claims
Monitors and analyzes billing processes to identify areas for improvement and implement solutions
Ensures daily reconciliation of claims transmitted to claims acceptance is completed in a timely manner
Manages accounts receivable, ensuring collections are optimized and follow-up processes are timely and efficient
Utilizes and creates Epic WQs to best manage and segment the assigned work to team members to ensure productivity standards are met and all AR is managed timely
Regularly completes denial management trending and root cause analysis to implement denial prevention strategies
Serves as the primary point of contact for EPIC-related billing processes and configurations
Ensures optimal utilization of the EPIC system to streamline workflows and enhance billing and AR efficiency
Collaborates with IT and EPIC support (CTC) teams to resolve technical issues and implement system updates
Follows ticket management processes and criteria when needing technical system support or updates
Prepares and presents regular reports on revenue cycle performance, billing metrics, key performance indicators (KPIs), and trends
Prepares month end results reporting packages
Define and meets/exceeds AR management and cash collections goals
Analyzes data to identify opportunities for revenue growth and process enhancements
Develops and implements strategies to reduce denials and improve collections
Ensures all billing activities comply with state and federal regulations, including those specific to FQHCs and Massachusetts healthcare laws
Maintains knowledge of Medicaid, Medicare, and commercial insurance policies applicable to FQHCs
Works closely with clinical, administrative, and finance teams to ensure alignment on billing/AR practices and revenue goals
Works closely with vendors and other third parties to facilitate timely and accurate data capture and collections
Represents the billing department in audits, meetings, and organizational planning sessions
Consistently provides service excellence to all patients, family members, visitors, volunteers, and co-workers in a manner that reflects C3s mission and core values
Other duties as assigned

Required Skills:

Proficiency with Epic systems, including configuration and reporting
A minimum of 5-7 years of progressive experience in healthcare billing, with at least 2-3 years in a managerial role
Strong knowledge of Massachusetts healthcare billing regulations and payer requirements
Strong leadership, excellent communication skills across stakeholders, attention to detail, and critical thinking skills
Results driven and outcome focused
Must be innovative, comfortable with ambiguity, well-organized, and committed to moving quickly and collaboratively in the context of a rapidly changing organization
Experience with quality improvement/change management and project management
Proficiency in Microsoft Office Suite
Must have a strong commitment to quality assurance and exceptional customer service
A strong commitment to the organizations mission

Desired Other Skills:
Certification in medical billing or coding (e.g., CRCR, CPC, CPB) is a plus
Epic certification in charge router, professional billing/Resolute, or other Epic EHR functionality
Familiarity with the MassHealth ACO program
Experience working in Federally Qualified Health Centers (FQHC)
Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Qualifications:
Bachelors degree in healthcare administration, business, finance, or a related field preferred

** In compliance with Covid-19 Infection Control practices per Mass.gov recommendations, we require all employees to be vaccinated consistent with applicable law. **