Location: Remote

Organization Summary:

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 day-to-day management and oversight of billing and accounts receivable activities for our FQHCs that are on our instance of Epic and/or in our Shared Services model. The ideal candidate will manage and support a team of billing A/R Specialists, ensuring compliance with state and federal guidelines, optimizing accounts receivable performance, and supporting C3 and our FQHCs’ financial goals. The position works closely with the Director of Billing to manage the billing team, monitor billing workflows, perform denial management, and support timely claim resolution, follow-up, and reporting. The Billing and Accounts Receivable Manager should have proficiency in using Epic, a solid understanding of healthcare billing regulations, particularly in Massachusetts, and a background in FQHC billing is preferred.

Responsibilities:

• Supervises and mentors the A/R Specialists, providing training and support to maintain high standards of accuracy and productivity
• 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
• Supports the development, updating, and maintenance of policies and procedures governing billing and collections 
• Identifies and recommends process and technology improvements to improve the effectiveness and efficiency of revenue cycle operations. 
• 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 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 assist in denial prevention strategies
• Serves as a point of contact for EPIC-related billing processes
• 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
• Monitors progress towards AR management and cash collections goals
• Recommends, supports, 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 vendors and other third parties to facilitate timely and accurate data capture and collections
• 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 billing workflows, work queues, reporting, and issue resolution
• A minimum 5 years of progressive experience in healthcare billing, including supervisory or team lead experience preferred
• 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
• Proficiency in Microsoft Office Suite
• Must 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
• Experience with Epic EHR functionality
• Familiarity with the MassHealth ACO program
• FQHC billing experience preferred
• 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

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