Revenue Cycle Supervisor

Job Summary

The Revenue Cycle Supervisor is a working supervisor responsible for overseeing daily operations of KIC’s billing, claims, denials management, and accounts receivable functions across all service lines and billing systems. This position performs direct production work in denial management and AR follow-up while providing operational supervision to billing clerks, coding staff, and AR personnel. The Supervisor ensures timely, accurate claim submission and maximum reimbursement across Medicaid (including tribal encounter rate), Medicare, commercial insurance, IHS Purchased/Referred Care, VA, and other payers. This position works in close coordination with the Patient Access Supervisor to ensure seamless handoffs between front-end registration/eligibility verification and back-end billing/collections. This position is responsible for daily operations, staff oversight, workflow execution, denials production, KPI data gathering, and issue escalation. The position must be aware of and sensitive to the fact that KIC’s purpose is to serve its Tribal members.

Job Duties & Responsibilities

• Oversee daily claim submission across all billing systems; assign and monitor work queues, track staff productivity, and ensure claims are submitted accurately and within payer-specific timely filing limits.
• Personally work complex denials, payer appeals, and high-dollar AR follow-up as a primary production function of the role.
• Monitor denial trends and categorize root causes (payer, coding, documentation, system errors); track denial rates, overturn rates, and recovery amounts by payer and category, and report trends to the Revenue Cycle Director.
• Establish and enforce AR aging thresholds; monitor aging daily and reassign workload to address backlogs, with priority focus on high-dollar accounts and claims nearing timely filing limits.
• Ensure proper payer sequencing for AI/AN beneficiaries to maximize tribal encounter rate capture and 100% FMAP reimbursement.
• Collaborate with Patient Access team to resolve eligibility, registration, and insurance capture issues impacting claim submission; communicate barriers to collections to the Revenue Cycle Director.
• Directly supervise billing clerks, coding staff, and AR personnel; provide day-to-day coaching, cross-training on multiple billing systems, and conduct performance evaluations.
• Develop and maintain written standard operating procedures for billing, denials, and AR functions; orient new team members to workflows, systems, and performance expectations.
• Identify and flag coding-related denials, coding lag times, and chart closure delays to the Revenue Cycle Director; coordinate with coding staff and clinical departments as directed.
• Gather and validate revenue cycle data to support the Revenue Cycle Director’s performance reporting; identify revenue leakage and process inefficiencies observed in daily operations and report findings for analysis.
• Document system issues, workflow inefficiencies, and billing errors across all platforms; escalate configuration and optimization needs to the Revenue Cycle Director. Implement workflow and billing changes as directed in response to payer or regulatory updates.
• Monitor held claims for enrollment-related billing delays; flag claims held due to incomplete provider enrollment to the Revenue Cycle Director for escalation.
• Ensure all billing and collections activities comply with applicable federal, state, and tribal regulations, including HIPAA, CMS guidelines, and IHS policies. Maintain sensitivity to the cultural values of KIC’s Tribal members and AI/AN beneficiary population.
• Other related duties as assigned.
• Assign and reassign daily work across billing, denials, and AR functions.
• Enforce workflows, productivity expectations, and standard operating procedures.
• Provide input on staff performance evaluations and recommend corrective actions.
• Personally work and resolve complex denials, payer appeals, and high-dollar AR accounts.
• Escalate to the Revenue Cycle Director: policy changes, system issues requiring vendor or partnership engagement, financial or strategic concerns, staffing structure decisions, and payer contract issues.
• Other related duties as assigned.

Necessary Knowledge, Skills, and Abilities

• Strong understanding and sensitivity to American Indian/Alaska Native (AI/AN) Tribal culture and lifestyle, working effectively with AI/AN populations.
• Knowledge of healthcare revenue cycle processes from patient registration through collections, including charge capture, coding, claim submission, payment posting, denial management, and AR follow-up.
• Knowledge of multi-payer billing requirements including Medicaid, Medicare, commercial insurance, VA/CHAMPVA, and IHS Purchased/Referred Care.
• Knowledge of medical terminology, CPT, ICD-10-CM, CDT, and HCPCS coding systems sufficient to review claims and coordinate with coding staff.
• Knowledge of HIPAA privacy and security requirements as applied to revenue cycle operations.
• Effective oral and written communication skills, including the ability to explain complex billing and payer issues to clinical staff, providers, and leadership.
• Skills in operating personal computers using a variety of computer software, including multiple healthcare billing platforms, electronic health records, and clearinghouse systems.
• Skill in supervising, coaching, and developing staff in a professional healthcare environment.
• Skill in analyzing AR aging reports, denial trends, and revenue cycle performance data to identify problems and implement solutions.
• Ability to establish and maintain cooperative working relationships with management, coworkers, and outside contacts.
• Ability to maintain strict confidentiality and comply with all applicable federal and tribal privacy laws and KIC policy (HIPAA, HITECH, etc.).
• Ability to manage multiple priorities and tasks concurrently and meet deadlines across multiple billing systems and payer types.
• Ability to work independently as well as with teams.
• Proficiency in Microsoft Excel and basic reporting tools for data analysis and reporting.
• Ability to maintain attention to detail in a high-volume, deadline-driven environment.
• Ability to adapt to changing priorities, systems, and payer requirements.

Working Conditions

The physical demands described here are representative of those that an employee must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform these functions.

While performing the duties of this Job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is frequently required to stand and/or sit. The employee is occasionally required to walk, sit, climb, or balance. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, peripheral vision, and depth perception. The noise level in the work environment is usually average.

KIC Core Competencies

Cultural Competency: To be respectful and responsive to the health beliefs, practices, and cultural and linguistic needs of KIC Tribal Members. Developing cultural competence is an evolving, dynamic process that takes time and occurs along a continuum.

Uphold KIC Values: To make decisions and behave in a manner consistent with KIC Workplace Values of Trust, Teamwork, Respect, and Accountability, as well as Southeast Traditional Tribal Values “Our Way of Life”.

Commitment: To serve Tribal Members and set a high standard for yourself in your performance; strive for results and success; convey a sense of urgency and bring issues to closure; and stay persistent despite obstacles and opposition.

Customer Service: Meet/exceed the expectations and requirements of internal and external customers; identify, understand, and monitor the needs of both internal and external customers; always talk and act with customers in mind; and recognize working colleagues as customers.

Effective Communication: Ensure important information is passed to those who need to know; convey necessary information with respect, clearly and effectively orally or in writing

Responsiveness and Accountability: Demonstrate a high level of conscientiousness; hold oneself personally responsible for one's own work; and do the required fair share of work.

Qualifications

Minimum Qualifications (Education & Experience)

• High school diploma or equivalent.
• Two (2) years of experience in healthcare revenue cycle operations, including direct experience in medical billing, claims processing, denial management, or accounts receivable follow-up.
• One (1) year of lead, team coordination, or demonstrated leadership responsibility in a healthcare setting.
• A combination of relevant experience, education, and training may substitute for education and experience requirements on a year-for-year basis.
• Have or complete an approved professional development program relevant to healthcare revenue cycle management (e.g., AAPC CPB or CPC certification, MGMA, HFMA) within twelve (12) months of hire.

Preferred Qualifications (Education & Experience)

• Bachelor’s degree in healthcare administration, business, health information management, or related field.
• Five (5) or more years of healthcare revenue cycle experience with progressive responsibility.
• Current CPB (Certified Professional Biller), CPC (Certified Professional Coder), CRCR (Certified Revenue Cycle Representative), relevant MGMA (Medical Group Management Association) Certifications or equivalent.
• Experience in tribal health, IHS, or FQHC revenue cycle operations, including familiarity with Alaska Medicaid tribal encounter rate mechanics and the 100% FMAP pass-through for AI/AN beneficiaries.
• Experience with Cerner Millennium, INSYNC, Dentrix, or comparable healthcare billing platforms.
• Experience with denial management analytics, root cause analysis, and payer appeals processes.
• Experience in community clinic preferred and a strong commitment to multi-disciplinary teamwork.

Conditions of Hire

• May be required to possess and maintain a valid driver's license or capable of obtaining one, as well as be insurable by KIC’s company insurance.
• KIC is a Drug-Free Workplace. All employees must adhere to KIC drug and alcohol policies and procedures to ensure a safe workplace. Employees must pass a pre-employment and subsequent random and/or for-cause drug and alcohol screening to be eligible for and maintain employment.
• KIC has several positions that must comply with the P.L. 101-630 Indian Child Protection and Family Violence Protection Act (ICPA); all employment offers in the "covered" classification are conditional until KIC has received a federal criminal background check verifying eligibility to work in these programs.