Job Title: Revenue Cycle Director
Department: Administration
Reports To: Chief Finance Officer (CFO)
Salary Level: DOE
FLSA Status: Exempt
Approved By: Chief Executive Officer (CEO)
Approved Date: February 2026
SUMMARY The Director of Revenue Cycle is responsible for the strategic oversight, management, and optimization of all revenue cycle functions for K’ima:w Medical Center (KMC). This includes patient registration, coding, billing, claims management, collections, reimbursement optimization, compliance, and reporting. The position ensures maximization of revenue while maintaining compliance with federal, state, tribal and payer regulations, including Indian Health Service (IHS), Federally Qualified Health Center (FQHC), Medicaid, Medicare, private insurance, and grant funding requirements.
This role supports the clinic’s mission of delivering high-quality healthcare services to tribal members and the surrounding community while strengthening financial sustainability.
Essential Duties & Responsibilities
The Revenue Cycle Director is the first line supervisor to the Revenue Cycle Team. Manages Revenue Cycle staff to ensure efficient and timely billing and collections from health care-related insurance. Develops, negotiates, and monitors all third-party payor contracts to ensure compliance, optimize reimbursement, and support the financial sustainability of K’ima:w Medical Center. Acts as the primary advisor on all revenue cycle matters as those relate to maximizing and effectively managing revenue streams.
Revenue Cycle Management
- Direct and oversee all revenue cycle functions including registration, eligibility verification, coding, billing, collections, denial management, and accounts receivable.
- Ensure effective flow of demographic charge and payment information.
- Develop and implement strategies to optimize reimbursement and reduce revenue leakage.
- Maximize revenue growth through identifying gaps or opportunities within organization.
- Monitor key performance indicators such as days in A/R, reimbursement trends.
- Ensure timely claim submission and follow-up on unpaid claims.
Compliance & Regulatory Oversight
- Ensure compliance with HIS, FQHC, Medicare, Medicaid, HIPAA, and tribal regulatory requirements.
- Maintain adherence to payer contract requirements and billing regulations.
- Oversee coding compliance and audit processes to minimize risk exposure.
Financial Oversight
- Collaborate with finance leadership on revenue projections, budgeting, and financial reporting.
- Analyze revenue cycle data to identify trends and opportunities for improvement.
- Assist with grant reporting and third-party reimbursement reconciliation.
- Oversees follow-ups with accounts receivables (A/R), including preparation of denial appeals and distribution of patient statements.
- Track fee schedules and insurance denials to ensure fully allowed reimbursement.
Leadership & Staff Management
- Provider leadership, supervision, training, and performance evaluation of revenue cycle staff.
- Promote staff development, retention, and a collaborative work environment.
- Foster cross-department coordination with clinical, HR, Compliance, and finance teams
System & Process Improvement
- Oversee electronic health record (EHR) billing functions and revenue cycle technology.
- Implement process improvements to increase efficiency and reduce billing errors.
- Ensure data integrity and reporting accuracy.
- Must have knowledge and experience in both RPMS and EPIC.
Community & Tribal Engagement
- Support the organization’s mission and cultural values in serving tribal communities.
- Collaborate with leadership on initiatives improving patient access and financial sustainability.
- Maintain sensitivity to tribal sovereignty, community health needs, and cultural considerations.
SUPERVISORY RESPONSIBILITIES:
Supervises all departments under the revenue cycle, consisting of billing, collection, financial reporting, compliance, patient benefits, staff training, technology integration.
OTHER ESSENTIAL DUTIES AND RESPONSIBILITIES
- Knowledge of Resource and Patient Management System and Electronic Health Records (Indian Health Service) and EPIC software.
- Review, design, and implement processes surrounding admissions, pricing, billing, third party payer relationships, compliance, collections and other financial analyses to ensure revenue cycle is effective and properly utilized.
- Track and report numerous metrics related to the patient engagement cycle including recording coding error rates and billing turnaround time to develop sound revenue cycle analysis and reporting.
- Manage relations with payers and providers to generate high reimbursement rates and a low level of denials.
- Works directly with the finance office on all Revenue Cycle reporting and reconciling.
- Prepare and supply financial information for the auditors for the fiscal year end.
- Assist in preparing, validating and submitting Revenue Cycle information for the Medicare Cost Reports to the auditors.
- Manages staff schedule and coordinates all time off request.
- Communicate with, guide, and educate patients regarding billing questions and concerns.
- Review and/or approve all Sliding Fee Applications.
- Oversee all patient-related A/R payments posted and deposited.
- Balance and reconcile bank deposits for Accounts Receivable.
- Assist in billing and follow up on patient accounts as needed.
- Prepare for and attend all required meetings.
- Assist in keeping Provider Enrollment current for all necessary payers, provide updates as needed, and assist with the enrollment of each new Provider and Locum.
- Ability to work with people of different skill sets and backgrounds, helping them achieve their maximum potential.
- Ability to master in-house computer and software required.
- Active knowledge of clinical terminology preferred.
- Analytical ability to evaluate and interpret clinical data.
- Clerical ability to operate a variety of office machines and competent keyboarding skills.
- Knowledge of filing regulations, guidelines, and office procedures.
- Ability to work independently under established priorities and deadlines.
- Knowledge of maintaining and managing files and records.
- Knowledge of grammar, spelling, punctuation, and common technology.
- Competent level of Windows based skill.
- Knowledge of Microsoft Excel and Word.
- Sound judgment, tact, and confidentiality for all related work required.
- Must be able to identify and maintain confidential information.
- Must sign a confidentiality statement.
- Must be punctual and willing to work additional hours if necessary.
- Must be able to perform all job duties in stressful situations.
EDUCATION and/or EXPERIENCE:
- Bachelor’s degree (B.A.) from four-year college or university, OR equivalent proven work experience is required.
- Must have at least 5 years of revenue cycle experience, which can include a combination of medical billing, coding, front-office, insurance, physician practice management and healthcare business processes.
- Strong understanding of medical billing/coding, with understanding of various insurance carriers, including Medicare, private HMOs, and PPOs. Exceptional written, verbal and interpersonal communication skills required.
- Professional demeanor required.
CERTIFICATES, LICENSES, REGISTRATIONS:
- Current CPR certificate or can obtain one within 90 days of hire.
- CRCS certification: A Certified Revenue Cycle Specialist (CRCS) is a health care finance professional who obtained exclusive credentials through the American Association of Health Care Administrative Management (AAHAM), preferred or willing to obtain within first two years of employment.
CONFIDENTIALITY: Employee must be aware of and adhere to K'ima:w Medical Center's Confidentiality Policy and always deals appropriately with patient confidentiality.
CONDITIONS OF EMPLOYMENT: Employment with K’ima:w Medical Center (KMC0 is contingent upon compliance with all applicable tribal federal, and organizational policies and regulations. Employees are subject to Title 21, Drug and Alcohol Policies Ordinance of the Hoopa Valley Tribe, and the Federal Workplace Act, Title 30A, Employment Background Check Policy, which includes fingerprinting. Preference will be given to qualified Native American applicants in accordance with Title 13, Tribal Employment Rights Ordinance (TERO). All employees are required to successfully complete pre-employment screening requirements and will serve an initial (90) day introductory period. Continued employment is contingent upon satisfactory job performance, adherence to organizational policies. Employees will serve an initial 90-day introductory period, and annual performance evaluations thereafter.
ANNUAL TRAINING REQUIREMENTS: At a minimum Employee is required to be certified for the following training 1) Health Stream courses and 2) CPR.