Director of Revenue Cycle Management

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage daily revenue cycle operations for a group of behavioral health clients in Maryland.

• Oversee benefits verification, eligibility checks, authorizations, claim creation and submission, payment posting, reconciliation, denial management, appeals, collections, patient responsibility, and patient statements.

• Lead and supervise billing managers, billing specialists, authorization/VOB staff, and other members of the revenue cycle management (RCM) team.

• Monitor billing activities to ensure claims are submitted accurately and promptly.

• Supervise billing and reimbursement processes for Maryland Medicaid/PBHS, Carelon Behavioral Health, commercial insurance, and other payers.

• Track accounts receivable and follow up on unpaid, underpaid, rejected, and denied claims.

• Analyze aging reports to identify trends impacting collections.

• Formulate corrective action plans to address denials, aging accounts receivable, authorization issues, and reimbursement challenges.

• Review reimbursement in relation to fee schedules and contracted rates while identifying underpayments.

• Oversee denial management and payer appeals processes.

• Establish and track client account KPIs, such as clean claim rate, denial rate, days in accounts receivable, aging, collection rate, authorization-related denials, outstanding accounts receivable, and monthly collections.

• Provide regular revenue cycle reports to Revive and client leadership.

• Participate in client meetings to discuss billing performance, issues, corrective actions, and recommendations.

• Develop standardized billing workflows, policies, procedures, internal controls, and account-specific processes.

• Assist in onboarding new RCM clients, encompassing EHR and clearinghouse setup, payer configuration, billing matrices, fee schedules, workflows, reporting, and transitions.

• Collaborate with credentialing and consulting teams on enrollment, licensing, credentialing, and operational challenges.

• Ensure compliance with Maryland Medicaid, Carelon, Medicare when applicable, commercial payer requirements, HIPAA, and relevant regulations.

• Stay updated on Maryland behavioral health reimbursement, billing, authorization, payer, fee schedule, and coding changes.

• Recruit, train, supervise, and evaluate RCM staff.

• Identify opportunities for automation, workflow improvements, and technology enhancements to boost efficiency and collections.

• Act as the primary internal escalation point for intricate billing, reimbursement, payer, and revenue cycle matters.

⛳️ Requirements

• At least 5 years of experience in healthcare revenue cycle management, with significant leadership or management responsibilities.

• Direct experience with Maryland behavioral health billing is essential.

• Strong understanding of Maryland Medicaid/PBHS and Carelon Behavioral Health is required.

• Experience with billing for outpatient mental health clinics (OMHC) and/or substance use disorder treatment services.

• Comprehensive knowledge of behavioral health authorizations, eligibility verification, claims submission, payment posting, denials, appeals, collections, and accounts receivable management.

• Proven ability to manage multiple client accounts, locations, programs, or billing entities simultaneously.

• Capability to analyze accounts receivable and reimbursement data, translating findings into operational enhancements.

• Experience in supervising and developing billing teams is preferred.

• Knowledge of CPT, HCPCS, ICD-10, modifiers, payer-specific billing requirements, and behavioral health reimbursement methodologies.

• Familiarity with behavioral health EHRs, clearinghouses, payer portals, and electronic claims/remittance systems.

• Proficient in Excel/Google Sheets and reporting skills.

• Excellent written and verbal communication abilities.

• Highly organized with the capacity to manage competing priorities and deadlines effectively.

• Strong problem-solving skills and the ability to independently research and resolve complex payer and reimbursement issues.

• Preferred: experience with various Maryland behavioral health levels of care, Carelon, Medicaid EVS, Availity, commercial payer portals, Maryland-specific authorization processes, EHR/billing system implementations or transitions, and third-party or multi-site behavioral health revenue cycle management operations.

• CPC, CPB, CRCR, or other relevant billing/revenue cycle certifications are preferred but not mandatory.

• A bachelor's degree in healthcare administration, business, finance, or a related field is preferred; equivalent relevant experience will be considered.

• Must be capable of operating at both the director and operational levels.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health and wellness benefits.

• Opportunities for professional development and advancement.

• Supportive work environment with a focus on teamwork and collaboration.