Director of Revenue Cycle Audit and Compliance

We are seeking an experienced and detail-driven Director of Revenue Cycle Audit and Compliance to lead and enhance compliance efforts within our organization’s revenue cycle. This critical leadership role ensures adherence to all applicable state regulations, Medicare, Medicaid, and other payer-specific billing guidelines. The ideal candidate is a strategic thinker with a proven track record of maintaining regulatory compliance in healthcare billing, preferably within behavioral health or addiction treatment settings.

As the Director of Revenue Cycle Audit and Compliance, you will play a pivotal role in safeguarding our organization’s integrity, improving operational efficiency, and ensuring financial accuracy while mentoring a team and fostering a culture of compliance.

Summary Of Essential Job Functions

The key responsibilities of the Director of Revenue Cycle Audit and Compliance include but not limited to:

Duties And Responsibilities

• Conduct comprehensive audits of claims and billing processes to ensure strict compliance with federal, state, and payer-specific regulations, including Medicare and Medicaid guidelines.
• Monitor billing practices to identify potential risks, non-compliance issues, or discrepancies related to state-specific regulatory requirements.
• Ensure all documentation, coding, and claims adhere to applicable laws, regulations, and billing standards.
• Develop and implement Standard Operating Procedures (SOPs) aligned with payer-specific requirements, including Medicare and Medicaid billing guidelines, to ensure consistent compliance and operational efficiency.
• Stay current on changes to Medicare, Medicaid, and state billing policies, providing regular updates and training to the revenue cycle team.
• Evaluate organizational policies and workflows to ensure alignment with regulatory requirements, addressing gaps as needed.
• Collaborate with billing, operational and clinical teams to develop corrective action plans for compliance issues uncovered during audits.
• Conduct root cause analyses to address recurring errors, ensuring ongoing compliance and operational improvements.
• Generate detailed audit reports, outlining findings, trends, and actionable recommendations for improving compliance and reimbursement outcomes.
• Provide guidance and training to staff on compliance requirements, payer updates, and best practices for documentation and billing.
• Act as a subject matter expert in state regulations and Medicare/Medicaid billing guidelines, advising on compliance strategies.
  
  

Qualifications

• Education: Bachelor’s degree in health information management, Healthcare Administration, Business, or related field (preferred).
• Experience:
• Minimum of 3-5 years of experience in revenue cycle auditing, billing, or a related role.
• Expertise in Medicare and Medicaid billing guidelines and state regulatory compliance is required.
• Experience with behavioral health or addiction treatment billing processes is highly preferred.
• Certifications: CPC, COC, CCS, or equivalent certification in coding and billing (preferred).
• Skills and Competencies:
• Strong analytical skills and attention to detail.
• In-depth knowledge of medical coding standards (ICD-10, CPT, HCPCS) and claims lifecycle management.
• Advanced knowledge of state and federal regulations governing healthcare billing and reimbursement.
• Proficient in electronic medical record (EMR) and billing systems.
• Outstanding communication, presentation, and interpersonal skills to effectively train and collaborate with diverse teams.
• Self-motivated leader with the ability to manage multiple priorities and drive organizational change.
  

Physical Requirements And Working Conditions

The physical demands described here are representative of the requirements that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions to the extent such accommodation does not create an undue hardship on the business.

• A variable workload, periodic high activity level.
• Vision adequate to read correspondence, computer screen, forms, etc.
• Sit for long periods of time, some bending, stooping and stretching
• Speaking and hearing ability sufficient to communicate effectively by phone or in person at normal volumes
• Keyboarding for long periods of time
  
  

Why BHG?

Join BHG, Where Your Career Flourishes In An Environment Built On Teamwork And Compassion. At BHG, We're Not Just a Team; We're a Family Dedicated To Patient Well-being And Professional Growth. Here's Why You Should Be Part Of Our Journey

Work-Life Balance: Enjoy generous paid time off for vacation, holidays, and personal needs. Benefit from flexible schedules with early in/early out hours, no nights, and no Sundays, ensuring you have time for self-care and personal commitments. Manageable workload.

Investment in Your Growth: BHG prioritizes your development through role-based training and advancement opportunities. Grow with us as we nurture your career path.

Comprehensive Benefits: Choose from three robust benefits programs, including health, life, vision, and dental insurance. Enjoy our tuition reimbursement program and competitive 401K match, along with medical, dental, vision care, life insurance, disability coverage, and vacation time.

Recognition and Rewards: Experience competitive pay, quarterly bonuses, and incentives for completing certifications or licenses.

Employee Perks: Access exclusive discounts on various services and entertainment options. Take advantage of our Employee Assistance Program and self-care series.

At BHG, we thrive on the greatness of our people. Join us and become part of a community that values excellence, integrity, and making a real difference in the lives of others.

BHG is an equal opportunity, affirmative action employer providing equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, national origin, protected veteran status, disability status, or any other legally protected basis, in accordance with applicable law.