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
Organization Summary:
Community Care Cooperative (C3) is a 501(c)(3) non-profit multi-service organization 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 fulfill two primary business functions for the FQHCs we work with. First, we are an FQHC-led accountable care organization (ACO); second, we are a Management Services Organization (MSO) for FQHCs. As an ACO, we negotiate value-based payor contracts on behalf of our FQHCs, hold and operate those contracts (including fulfilling many compliance, financial management, and population health management functions), and maximize the return to FQHCs of any incentive dollars earned. We are proud to be the market leader in the MassHealth ACO Program. We are the largest Medicaid ACO in Massachusetts, and we operate a variety of business offerings nationwide. As an MSO, we (along with our subsidiary companies, which are also FQHC-led non-profits) provide several financial, operational, and technological services to groups of FQHCs. These services include Epic EHR licensing and implementation; pharmacy operations consulting as well as the building and direct operation of on-site retail pharmacies; billing and credentialing; employer-sponsored insurance; and others. We are a fast-growing, dynamic 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 FQHCsWorks 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 C3's mission and core values
- Other duties as assigned
Required Skills:- Proficiency with Epic systems, including configuration and reporting
- A minimum of 7-10 years of progressive experience in healthcare billing, with at least 3-5 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 SuiteMust have a strong commitment to quality assurance and exceptional customer service
- A strong commitment to the organization's 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:
Bachelor's degree in healthcare administration, business, finance, or a related field preferred
