Director of Revenue Cycle Management

🕒 vor 1 Monat

🇺🇸 Vereinigte Staaten – Remote

💵 $90.000 - $110.000 / Jahr

⏰ Vollzeit

🔴 Experte

👔 Direktor

👻 Geisterscore 7%

Was es bedeutet: die Wahrscheinlichkeit, dass für diese Stelle niemand wirklich einstellt.So liest du es: 60 % oder höher heißt, wir halten das für einen Geisterjob. Niedrigere Werte sind weniger bedenklich.Warum dieser Wert:

• Seit 43 Tagen offen.

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Revive BHS

WebsiteLinkedInAlle Stellen

2 - 10 Mitarbeiter

🏥 Gesundheitswesen

💼 Beratung

🤝 B2B

Healthcare • Consulting • B2B

Revive BHS ist eine Beratungsgesellschaft im Bereich der Verhaltensgesundheit, die Einrichtungen für Suchthilfe, psychische Gesundheit, Doppeldiagnosen und psychiatrische Behandlungen bei einem ethischeren und effizienteren Betrieb unterstützt. Sie bieten Dienstleistungen in den Bereichen Ertragszyklusmanagement und medizinische Abrechnung, Versicherungsakkreditierung, Compliance und Audits, Programmentwicklung, Lizenz- und Akkreditierungsunterstützung (CARF, The Joint Commission, ACHC), Ablehnungsmanagement sowie betriebswirtschaftliche und finanzielle Beratung, um Abläufe zu optimieren und die Qualität der Versorgung zu verbessern.

Beschreibung

• 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

🎯 Anforderungen

• 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

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