Director, Revenue Cycle Management

This is a fully remote position, open to applicants in California, +1 more state.

📋 Description

• Develop cash flow forecasting models for the insurance ramp, encompassing DSO assumptions by payer, benchmarks for denial rates, and aging of receivables.

• Choose, configure, and take charge of the practice management and billing platform, ensuring integration with the organization's EHR and CRM systems.

• Create and uphold the denial management taxonomy, workflow for root-cause analysis, and resubmission processes specific to each payer.

• Manage payer credentialing and enrollment for all providers across targeted commercial payers in various states, utilizing a credentialing platform like Medallion or its equivalent.

• Establish and sustain CAQH profiles for all providers, ensuring compliance with a 90-day attestation cycle without interruptions.

• Oversee co-credentialing of supervising physicians in states requiring supervision, collaborating with the CMO to ensure necessary coverage is established before submitting claims.

• Monitor credentialing statuses, re-credentialing cycles, and effective dates of payer contracts within a system of record, treating credentialing and contracting as distinct workflows.

• Ensure the precise and justified use of behavioral health CPT codes, including psychiatric evaluation codes, E/M codes for medication management, and add-on psychotherapy codes according to AMA guidelines and specific payer billing rules.

• Formulate and enforce provider documentation standards that support the codes submitted, including DSM-criterion documentation, validated screening tools, and requirements for telehealth encounters.

• Supervise the pre-submission review of all claims by certified coders, ensuring accuracy in E/M level and appropriate ICD-10-CM diagnosis coding.

• Keep abreast of OIG Work Plan priorities for behavioral health and telehealth, adjusting internal audit protocols as necessary.

• Execute state-level payer analyses to identify the leading commercial payers by covered lives, aligning target payer selection with the organization's insurance launch strategy.

• Lead discussions on payer contracting in partnership with the CMO and General Counsel, tracking negotiated rates, contract terms, and effective dates.

• Create and maintain a payer performance dashboard that monitors denial rates, DSO, reimbursement rates, and outcomes of appeals by payer.

• Ensure the availability of audit-ready credentialing files and claim documentation that can withstand scrutiny from payers, state, or federal entities.

⛳️ Requirements

• Minimum of seven years of progressive revenue cycle experience within a behavioral health, psychiatric, or substance use disorder practice or health system environment; this is a non-negotiable criterion.

• Proven track record of building or significantly restructuring a revenue cycle operation from foundational infrastructure rather than merely managing an existing program.

• Extensive working knowledge of behavioral health CPT coding, including psychiatric evaluation codes, E/M codes for medication management, and psychotherapy add-on codes.

• Hands-on experience with commercial payer credentialing and enrollment in a multi-provider, multi-state context.

• Practical understanding of MHPAEA requirements and how to apply parity arguments in payer appeals.

• Familiarity with telehealth billing regulations, including place-of-service requirements and considerations for interstate licensure in telehealth claims.

• Experience in selecting and implementing practice management, billing, and clearinghouse platforms specifically in a behavioral health setting.

• Strong expertise in denial management, root-cause analysis, and the appeals processes related to behavioral health payer denials.

• Demonstrated ability to establish provider documentation standards that promote coding accuracy and audit defensibility.

• Comprehensive understanding of HIPAA Privacy and Security Rule requirements as they pertain to billing and revenue cycle operations.

• Preferred: Experience in a multi-state telehealth or digital health practice environment.

• Knowledge of 42 CFR Part 2 and its relevance to billing and records workflows for substance use disorder treatment.

• Familiarity with credentialing platforms such as Medallion, Verifiable, or similar alternatives.

• CPC, CCS, or CPMA certification from AAPC or AHIMA is required.

• Background in healthcare finance, including US GAAP as applied to revenue recognition and accounts receivable management.

• Experience collaborating within a clinically integrated model alongside a CMO or physician leadership team.

🏝️ Benefits

• U.S.-based role with a dedicated, HIPAA-compliant remote workspace.