Director of Revenue Cycle Management

🕒 Setembro 29

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $90.000 - $110.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Revive BHS

SiteLinkedInTodas as Vagas

2 - 10 funcionários

🏥 Saúde

💼 Consultoria

🤝 B2B

Healthcare • Consulting • B2B

Revive BHS é uma consultoria em saúde comportamental que auxilia instalações de tratamento de abuso de substâncias, saúde mental, diagnóstico dual e psiquiatria a operar de forma mais ética e eficiente. Eles oferecem gestão do ciclo de receita e faturamento médico, credenciamento de seguros, conformidade e auditorias, desenvolvimento de programas, suporte para licenciamento e acreditação (CARF, The Joint Commission, ACHC), gestão de recusas e consultoria operacional e financeira para otimizar operações e melhorar a qualidade do cuidado.

Descrição

• Oversee day-to-day revenue cycle operations for a portfolio of Maryland behavioral health clients • Manage verification of benefits, eligibility, 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 RCM team members • Monitor billing activity and ensure accurate, timely claim submission • Oversee Maryland Medicaid/PBHS, Carelon Behavioral Health, commercial insurance, and other payer billing and reimbursement • Monitor accounts receivable and follow up on unpaid, underpaid, rejected, and denied claims • Review aging reports and identify trends affecting collections • Develop corrective action plans for denials, aging A/R, authorization issues, and reimbursement problems • Monitor reimbursement against fee schedules and contracted rates and identify underpayments • Oversee denial management and payer appeals • Establish and monitor client-account KPIs, including clean claim rate, denial rate, days in A/R, aging, collection rate, authorization-related denials, outstanding A/R, and monthly collections • Provide regular revenue cycle reporting to Revive and client leadership • Participate in client meetings and communicate billing performance, problems, corrective actions, and recommendations • Develop standardized billing workflows, policies, procedures, internal controls, and account-specific processes • Assist with onboarding new RCM clients, including 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 issues • Ensure compliance with Maryland Medicaid, Carelon, Medicare when applicable, commercial payer requirements, HIPAA, and applicable regulations • Stay current on Maryland behavioral health reimbursement, billing, authorization, payer, fee schedule, and coding changes • Recruit, train, supervise, and evaluate RCM staff • Identify automation, workflow, and technology opportunities to improve efficiency and collections • Serve as primary internal escalation point for complex billing, reimbursement, payer, and revenue cycle issues

🎯 Requisitos

• Minimum of 5 years of healthcare revenue cycle management experience, including significant leadership or management responsibility • Direct experience with Maryland behavioral health billing is required • Strong working knowledge of Maryland Medicaid/PBHS and Carelon Behavioral Health • Experience billing for OMHC and/or substance use disorder treatment services • Thorough understanding of behavioral health authorizations, eligibility verification, claims submission, payment posting, denials, appeals, collections, and A/R management • Experience managing multiple client accounts, locations, programs, or billing entities simultaneously • Ability to analyze A/R and reimbursement data and translate findings into operational improvements • Experience supervising and developing billing teams • Knowledge of CPT, HCPCS, ICD-10, modifiers, payer-specific billing requirements, and behavioral health reimbursement methodologies • Experience with behavioral health EHRs, clearinghouses, payer portals, and electronic claims/remittance systems • Strong Excel/Google Sheets and reporting skills • Strong written and verbal communication skills • Highly organized with ability to manage competing priorities and deadlines • Strong problem-solving skills and ability to independently research and resolve complex payer and reimbursement issues • Preferred: experience with multiple 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 RCM operations • CPC, CPB, CRCR or other relevant billing/revenue cycle certification preferred but not required • Bachelor's degree in healthcare administration, business, finance, or related field preferred; equivalent relevant experience considered • Must be capable of operating at both director and operational levels