VP of Revenue Cycle

VP of Revenue Cycle Job Category: Finance Requisition Number: VPOFR001163 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 (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. SEE THE CARING HEALTH CENTER WEBSITE FOR MORE INFORMATION