From Planned Parenthood of Western Pennsylvania's posting. “We” and “our” refer to the employer.
Planned Parenthood of Western Pennsylvania (PPWP) is a not-for-profit family planning agency that provides high-quality, affordable reproductive health care. Our mission is to enable all Pennsylvanians to have access to a wide range of high-quality, affordable reproductive health care services. We help individuals make informed decisions about their reproductive health, family planning options, and sexuality.
We're looking for someone excited to expand a department, solve critical problems and support strategic growth of our care and services in the region. Change agents with a willingness to innovate and a foundational belief that providers like Planned Parenthood stand in the gap of our existing healthcare systems will thrive in this role. Successful candidates will bring a deep compassion for patients, strong analytical skills and systems-level thinking to the position.
Direct, evaluate and optimize all billing and revenue cycle activities for PPWP, including management of staff, and oversight of revenue cycle activities.
Financial Performance and Analytics
Develop and maintain reporting and dashboards to monitor key revenue cycle metrics including AR days, denial rates, clean claim rates, collections performance, and payer-specific trends.
Prepare and present revenue cycle performance reviews to executive leadership.
Coding Compliance and Education
Develop and deliver clinical billing and training content for providers and clinical front-end users; coordinate with Medical Services leadership to ensure consistent coding and documentation practices across the organization.
Act as the primary liaison between the billing department and internal departments ensuring clear communication, updates to billing processes and procedures, identification of trends, issue resolution, and continuous workflow improvement
Collaborate with Health Center Managers and Medical Services leadership to optimize front-end revenue cycle processes including patient registration, insurance verification, eligibility checking, sliding fee scale application, and point-of-service collections
Auditing Compliance and Grants Support
Ensure all billing activities comply with federal and state regulations, HIPAA privacy and security requirements, payer contract terms, and Planned Parenthood’s organizational standards and mission
Collaboratively review the coding audits with operations and IT analysts to identify training and system enhancements to improve compliant billing and coding.
Support billing and documentation requirements for the Title X Family Planning Program, including sliding fee scale compliance, service coding, and federal reporting obligations
Payer Relations and Contract Management Support
Direct third-party payer contract negotiations, management, and payer relations, including MCO contracts, fee schedule reviews, and dispute resolution.
Ensure complete, accurate, and timely data is maintained in Epic and that internal operations supports clean claim submission; identify and resolve data or workflow gaps that impact billing performance
Strategy and Special projects
Actively participate in strategic discussions and planning activities in collaboration with the Chief Financial Officer and Chief Executive Officer.
Manage Revenue Cycle Work Plan and actively execute various projects and initiatives identified in prior Revenue Cycle assessments, approved work plan and identified priorities.
Manage the risk assessment and quality management process and activities of the Revenue Cycle, including the following:
Revenue optimization initiatives and needs for PPWP team
Evaluation of risk areas, including mitigation of identified risks
Actively participate in any financial and other compliance audits, specifically related to Revenue Cycle.
Liaise with other PA affiliates to strategize state-wide revenue enhancement
Staff Leadership and Development
Recruit, onboard, develop, and retain a small revenue cycle team; set clear performance expectations and conduct regular performance evaluations
Foster a culture of accountability, continuous improvement, and mission alignment within the revenue cycle function
Perform other duties as assigned by the Chief Financial Officer
Education and Experience: Education: Bachelor’s degree in Accounting, Finance, Healthcare Administration, Business, or a related field preferred; equivalent combination of experience and education considered.
Experience: Minimum of three (3) years in a leadership or director-level role
Minimum of two (2) years of direct, hands-on experience with Epic Resolute Professional Billing required.
Experience in reproductive health, family planning, community health center (FQHC), or women’s health settings strongly preferred
Knowledge, Skills and Abilities: Epic & Technology
Expert-level working knowledge of Epic Resolute Professional Billing, including claim submission, work queue management, ERA/EOB processing, RTE, and reporting tools
Advanced proficiency in Microsoft Excel (pivot tables, VLOOKUP, data modeling)
Familiarity with clearinghouse platforms (e.g., Availity, Change Healthcare/Optum) and electronic claim submission processes
Coding & Compliance
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Thorough knowledge of CPT, ICD-10-CM/PCS, and HCPCS Level II coding, with specific familiarity with reproductive health service coding including contraceptive management, family planning, and abortion services
Strong understanding of federal and state Medicaid programs, Medicaid MCO billing requirements, and managed care contract structures
Knowledge of Title X program billing requirements, sliding fee scale regulations, and federal family planning service documentation standards
Familiarity with HIPAA privacy and security regulations and their application to billing, data sharing, and vendor management
Understanding of value-based payment models and quality-based incentive structures as they affect revenue cycle operations
Leadership & Communication
Proven ability to lead, develop, and motivate a diverse team in a multi-site, mission-driven healthcare environment
Excellent analytical, strategic, and problem-solving skills; ability to translate complex data into clear, actionable insights for executive and clinical audiences
Strong oral and written communication skills; able to present ideas convincingly and concisely to both technical and non-technical stakeholders
Strong commitment to reproductive health equity, patient-centered care, and Planned Parenthood’s mission and values
Well organized with demonstrated ability to manage competing priorities, set timelines, and drive results
Ability and willingness to travel to affiliate health center locations as needed
Planned Parenthood of Western Pennsylvania is an equal employment opportunity employer and is committed to maintaining a non-discriminatory work environment, and does not discriminate against any employee or applicant for employment on the basis of race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity, or any other characteristic protected by applicable law.
PPWP is committed to creating a dynamic work environment that values diversity and inclusion, respect and integrity, customer focus, and innovation.
Candidates must be legally authorized to work in the United States at the time of hire and throughout their employment. This position is no eligible for employment visa sponsorship, now or in the future.
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