Description
Who We Are
St. Francis Healthcare System of Hawai‘i uplifts families through compassionate care and a strong commitment to community. Guided by our mission to provide excellent, ‘ohana-centered hospice and supportive services, we remain rooted in our core values of grace, peace, unity, and legacy. Every team member plays a vital role in living this mission with heart, dedication, and a spirit of service. We cultivate a supportive environment where excellence is nurtured, teamwork is celebrated, and each person's contribution is valued. At St. Francis, healthcare is more than a profession—it's a calling. We welcome you to join our team and help carry forward our legacy of caring for Hawai‘i's people with purpose and aloha.
About the Role
The Revenue Cycle and Credentialing Manager is responsible for managing provider credentialing and payer enrollment activities and overseeing revenue cycle processes. This role ensures timely provider enrollment, compliance with Medicare, Medicaid, and commercial payer requirements, and effective revenue cycle operations from charge capture through collections. The position plays a critical role in supporting compliant billing, optimizing reimbursement, and maintaining financial sustainability for the organization.
Provider Credentialing and Enrollment
- Performs provider credentialing and enrollment services for hospice physicians, nurse practitioners, and other clinical providers with Medicare, Medicaid, and commercial payers, as assigned.
- Obtains missing credentialing and enrollment applications and forwards them to providers for completion, providing assistance and clarification as needed.
- Reviews credentialing and enrollment applications for accuracy, completeness, and compliance with payer and regulatory requirements prior to submission.
- Submits applications and required documentation to payers and insurers for review and approval.
- Monitors credentialing and enrollment applications throughout the approval process and conducts proactive follow-up with payers until final determination.
- Tracks approvals and ensures timely receipt of provider billing numbers to avoid interruptions in billing.
- Creates and maintains a credentialing and enrollment matrix for all hospice providers.
- Creates, maintains, and updates a centralized credentialing database, ensuring accurate provider records, renewal tracking, and recredentialing timelines.
- Assesses the hospice revenue cycle, including how and when claims are generated, processed, paid, denied, and followed up on.
- Evaluates compliance with hospice-specific billing requirements, including Medicare hospice benefit rules, levels of care, face-to-face encounters, physician certifications, and election statements.
- Reviews current accounts receivable (A/R) management practices, identify trends and issues, and recommends strategies to reduce days in A/R and improve cash flow.
- Reviews charge entry processes to ensure services, levels of care, and dates of service are captured accurately and timely.
- Reviews payment posting processes to ensure payments, contractual adjustments, and denials are posted correctly.
- Identifies denial trends, enrollment-related billing delays, or credentialing gaps that impact reimbursement.
- Monitors and reports on key revenue cycle performance indicators (KPIs), including days in accounts receivable, clean claim rate, denial rate, and net collection rate, and develop plans to meet or exceed organizational benchmarks.
- Collaborates with billing staff, clinical leadership, and compliance teams to resolve revenue cycle issues and improve processes.
Compliance and Collaboration
- Ensures credentialing and billing practices align with hospice regulations, CMS requirements, and payer policies.
- Leads and coordinates the organization’s response to internal and external audits related to credentialing, enrollment, and revenue cycle activity; serves as the primary liaison with payers, CMS, and accreditation bodies. Serves as a resource to leadership regarding credentialing timelines, revenue risks, and payer requirements.
- Develops and documents policies, procedures, and workflows related to credentialing and revenue cycle management.
- Leads and mentors team, providing guidance and support on educational and developmental opportunities relevant to the position.
- Directly supervises the Business Services team, providing direction on internal process priorities, systems governance, performance expectations, and professional development goals.
- Establishes and drives a healthy team environment. Proactively addresses employee safety, morale and operational concerns.
- Evaluates the performance of programs and recommends solutions to improve performance, when needed.
- Responsible for interview, selection, orientation, training, performance management, and transfer/promotion of direct reports. Initiates disciplinary action and termination as appropriate in accordance with relevant policies, collective bargaining agreements, and job expectations.
- Monitors and ensures staff productivity, including schedules, overtime, time off and leaves, and absenteeism. Reviews and approves timesheets.
- Identifies opportunities to improve performance or enhance collaboration.
- Participates in inter-departmental committees, teams and task forces as needed.
- Actively and continuously seeks and attends educational opportunities.
- Performs other duties as assigned.
Requirements
Education / Training
- Bachelor’s degree in healthcare administration, business, finance, or a related field, or equivalent combination of education and experience.
Licensure and Certifications
- Certified Revenue Cycle Representative (CRCR) issued by the Healthcare Financial Management Association (HFMA), or Certified Revenue Cycle Professional (CRCP) issued by the American Association of Healthcare Administrative Management (AAHAM).
Experience and Other Qualifications
- At least 5 years of experience in healthcare revenue cycle management and provider credentialing, including 2 years in a leadership role.
- Prior experience in hospice, home health, or post-acute care strongly preferred.
- Experience working with Medicare hospice billing and enrollment requirements, Medicare hospice benefit regulations, and revenue cycle workflows.
- Demonstrated ability to manage staff, including planning work, assigning duties, coaching, and evaluating performance.
- Highly organized with strong attention to detail and the ability to manage multiple applications and deadlines.
- Analytical skills to assess revenue cycle performance and identify process improvement opportunities.
- Proficiency with credentialing databases, billing software, and Microsoft Office applications.
- Ability to exercise sound judgment, initiative, and discretion in a managerial capacity.
- Effective written and verbal communication skills.
- Strong interpersonal skills with the ability to work effectively with diverse professional and non-professional staff.
- Working knowledge of applicable laws, policies, procedures, and best practices.
- Demonstrated computer literacy, including proficiency with common office software and systems.
Summary
Benefits Overview
At St. Francis Healthcare System of Hawaiʻi, we believe in sharing the same heart and level of care for our team members as we do for the clients we serve. Our comprehensive benefits are designed with the whole employee in mind. From resources for Professional and Educational development opportunities to an employer matching 403(B) retirement plan, we seek to provide a workplace which helps our team members be their best. Below is a summary of just a few of our employee benefits:
- Medical, Dental, Drug & Vision Coverage
- Flexible Spending Account (for Health and Dependent Care)
- 403(b) Retirement Savings Plan with employer match
- Paid Time Off (PTO) and Extended Sick Leave benefits
- Educational Reimbursement and Professional Leave benefits
- Employee Assistance Program
- Much more!