Job Description

Revenue Cycle Management at HHN ensures that contracted services are accurately reflected, reconciled, and paid across all payers. This includes capitation reconciliation, encounter validation, claims oversight (where applicable), payment posting, variance analysis, and coordination with Operations and Clinical teams to resolve documentation or eligibility gaps. The function directly impacts cash flow, reporting accuracy, and HHN’s ability to scale responsibly.

Responsibilities

• Own and manage the full revenue cycle, from eligibility validation and encounter tracking through payment reconciliation and collections.
• Oversee capitation payment reconciliation, including validating census files, eligibility rosters, and payment accuracy against contract terms.
• Manage claims workflows where applicable, ensuring timely submission, correction, and follow-up.
• Partner with Operations and Clinical teams to resolve documentation, authorization, or eligibility issues impacting revenue.
• Maintain and improve revenue workflows within eClinicalWorks (ECW) and related payer portals.
• Identify revenue leakage, underpayments, or denial trends and implement corrective action plans.
• Develop and maintain revenue dashboards and reporting to support leadership decision-making.
• Ensure compliance with payer contracts, state regulations, and internal financial controls.
• Support payer audits, reconciliations, and inquiries related to billing and payments.
• Lead and develop revenue cycle staff or external vendors as applicable.
• Play an active role in payer onboarding, contract implementation, and operational readiness for new lines of business.

Skills Required

• Strong understanding of managed care revenue models, including capitation, PMPM, and value-based arrangements.
• Experience working with eClinicalWorks (ECW) or similar EHR/RCM systems.
• Proficiency with payer portals (IEHP, Molina, Anthem, CalOptima, etc.).
• Strong analytical skills, including reconciliation, variance analysis, and financial reporting.
• Ability to translate contract language into operational billing and reconciliation processes.
• Strong organizational skills and attention to detail.
• Experience with digital health, enhanced care models, or healthcare startups preferred.

Competencies

• Revenue Ownership – Understands how dollars move through the organization and takes accountability for outcomes.
• Operational Rigor – Builds structure, timelines, and controls that reduce errors and manual rework.
• Problem Solving – Identifies root causes of payment issues and resolves them efficiently.
• Cross-Functional Partnership – Works effectively with Operations, Clinical, and Leadership teams.
• Execution in Ambiguity – Comfortable operating in a start-up environment where systems and processes are still evolving.
• Judgment & Prioritization – Knows where to focus effort to protect cash flow and mitigate risk.
• Continuous Improvement – Seeks ways to streamline workflows and improve accuracy as volume grows.
• Demonstrated ability to lead, coach, and inspire high-performing billing teams in a fast-growing, payer-driven environment.
• Brings operational discipline—able to drive process standardization, ensure compliance, and optimize resource allocation in a mission-driven healthcare setting.

Job Requirements

• Education:
• Bachelor’s degree in Finance, Accounting, Healthcare Administration, or related field preferred.
• Experience:
• 3–5 years of experience in healthcare revenue cycle management, with experience in managed care or capitated environments strongly preferred.
• Specialty Area:
• Managed care, population health, value-based care, or similar environments.

• Certifications / Licenses:
• None required; CPC, CPB, or similar certifications are a plus.

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