Director of Revenue Cycle Management

This is a fully remote position, open to applicants in South Africa.

📋 Description

• Oversee all RCM operations and promote sustainable revenue growth in various behavioral health clinics.

• Develop and enhance our comprehensive revenue cycle — from authorization to collections.

• Shift billing operations entirely in-house and create a modern, data-centric RCM platform from scratch.

• Design and implement a fully integrated RCM system utilizing data from our EMR and billing software.

• Generate bi-directional data flows between EMR and billing applications to eliminate manual data entry and minimize errors.

• Create real-time dashboards to monitor clean claim rates, denial rates, days in A/R, and collections by payer.

• Automate eligibility verification, VOB lookups, claim scrubbing, and remittance processing.

• Analyze historical claims data to identify denial patterns and develop targeted remediation strategies.

• Create revenue forecasting models to aid financial planning.

• Recruit, train, and oversee a high-performing RCM team.

• Establish career development pathways for team members.

• Ensure adequate staffing for timely filing and prior authorization needs.

• Manage the transition from third-party billing to fully in-house billing operations.

• Implement and refine workflows in the EMR and billing platforms to optimize collections.

• Set up authorization and VOB processes to confirm all services are covered before delivery.

• Develop a robust denials management and appeals process across all payers.

• Supervise credentialing for all clinicians with applicable payers.

• Implement patient and payer collection strategies, including the management of third-party collections vendors.

• Create RCM reporting systems to monitor performance and achieve revenue targets.

• Reconcile A/R across bank accounts, billing software, and EMR.

• Propel year-over-year revenue growth through innovative solutions and process enhancements.

• Establish coding standards and policies to maximize appropriate reimbursements.

• Lead payer audit responses and create policies to mitigate audit risk.

• Ensure billing compliance with all payers.

• Manage overpayment reporting and guarantee timely refunds to payers.

⛳️ Requirements

• Demonstrated experience in a senior RCM leadership position, ideally within behavioral health, mental health, or a comparable healthcare environment.

• Extensive knowledge of EMR systems and billing platforms, with the capability to leverage data from both. (Familiarity with Kipu is advantageous.)

• Strong comprehension of payer contracting, credentialing, authorizations, and appeals.

• Experience in managing or establishing in-house billing operations.

• Analytical mindset with the ability to create dashboards, interpret data, and make decisions based on data insights.

• Exceptional leadership, communication, and organizational abilities.

🏝️ Benefits

• Flexibility to work during U.S. hours.

• Opportunity to work remotely from home.