VP of Revenue Cycle

VP of Revenue Cycle Job Category:
Finance Requisition Number:

VPOFR
001163 Full-Time Hybrid Springfield, MA 01103, USA Job Details

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 (Mass Health, 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,

Next Gen, 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

Key

Competencies:

FQHC Reimbursement Strategy & Compliance Revenue Cycle Analytics, Reporting & Performance Metrics Mass Health, 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

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 Mass Health, HSN, Medicare PPS, Medicaid ACOs, and state-specific billing regulations.

Review and validate quarterly Mass Health wrap payments and monthly capitation payments; report discrepancies and trends to CFO. Monitor payer policy changes and FQHC reimbursement guidance to ensure organizational readiness. SEE THE CARING HEALTH CENTER WEBSITE FOR MORE INFORMATION