Director of Revenue Cycle Management

Position Summary:

The Director of Revenue Cycle Management (RCM) will provide strategic leadership and operational oversight for all revenue cycle activities across our behavioral health and substance use disorder (SUD) treatment programs. This role is responsible for maximizing reimbursement and cash flow while ensuring compliance with federal, state, and payer-specific regulations. The Director will also be crucial in understanding and adapting to the evolving payer landscape, including navigating financial risks associated with new reimbursement models like value-based care. This role will drive process improvements, monitor key performance indicators (KPIs), and foster collaborative relationships with clinical, financial, and administrative stakeholders to achieve the organization's mission of providing accessible, high-quality care.

Key Responsibilities:

Strategic Leadership

• Develop and execute a strategic vision for the RCM department that aligns with the organization's overall financial goals and mission, serve as a strategic advisor to the CFO and leadership team on revenue cycle developments and trends in the larger payer environment.
• Assess and respond to current and future trends in behavioral health reimbursement, particularly focusing on the changing payer environment and the shift towards value-based care models, to ensure the organization's financial stability.
• Establish and maintain departmental policies, procedures, budgets, and work standards for all revenue cycle functions.
• Regularly prepare and present revenue cycle performance metrics, initiatives, and issue resolutions to leadership.

Navigating the Changing Payer Landscape & Risk Management

• Analyze the impact of new payment models, such as value-based contracts and alternative payment models (APMs), on the organization's revenue cycle.
• Identify, assess, and mitigate financial risks associated with evolving reimbursement structures, including potential penalties for not meeting outcome benchmarks in value-based care arrangements.
• Develop and implement strategies to ensure the organization is positioned to succeed under new payment methodologies, leveraging data and technology to manage performance.
• Stay abreast of legislative changes and policy updates impacting behavioral health reimbursement, such as enhanced payments for integrated care or crisis services.

Operational & KPI Management

• Oversee the end-to-end revenue cycle process, including patient registration, eligibility verification, coding, billing, payment posting, collections, and denial management.
• Develop and monitor key performance indicators (KPIs) such as Days in Accounts Receivable, Denial Rate, Clean Claim Rate, and Cash as a Percentage of Net Revenue to drive continuous improvement.
• Implement strategies to improve revenue capture, optimize cash flow, and reduce claim denials and rejections.
• Identify opportunities for process improvements and leverage technology to enhance efficiency and effectiveness across all revenue cycle functions.
• Conduct regular internal audits of revenue cycle processes to ensure accuracy and compliance, adapting to the complexities introduced by value-based care and APMs.
• Ensure all billing and collection activities are in strict compliance with federal, state, and HIPAA regulations, as well as payer contracts and new payment model requirements.

Culture, Collaboration, and a Stakeholder Approach

• Serve as a primary liaison between the RCM team and clinical, administrative, and finance departments to ensure accurate documentation, coding, and billing practices.
• Partner with operational teams to proactively identify and resolve issues that impact reimbursement and to ensure smooth RCM workflows. Serve as internal RCM expert and work cross-functionally on process improvements, project implementations and reporting. This includes collaborating with Contracting, Operations, Clinical Management, Finance, Learning and Development.
• Manage relationships and negotiate contracts with insurance carriers and other third-party payers to ensure favorable reimbursement rates and alignment with new payment models.
• Collaborate with clinical teams to support the utilization review process and ensure appropriate service authorization and reimbursement.
• In all duties, operate with a deep commitment to the organization's mission of providing compassionate and accessible behavioral health and SUD treatment to clients and their families.

Culture, Collaboration, and a Stakeholder Approach

• Lead, mentor, and supervise the RCM team, fostering a culture of accountability, collaboration, and continuous improvement.
• Set clear performance goals and expectations for the team and conduct performance evaluations to ensure staff development.
• Provide training and continuing education to leadership and staff on industry best practices, regulatory changes, and evolving payer requirements, particularly those related to new payment models and risk management.