Revenue Cycle Director

POSITION SUMMARY

The Revenue Cycle Director oversees key revenue cycle functions, including reporting, data analysis, and insurance relationship management, as well as overseeing the daily operations of the billing team, ensuring accurate and timely claims submission, payment posting, and overall billing processes. This role ensures compliance with insurance contracts, supports financial growth, and monitors KPIs such as DSO and denial rates to improve performance.

The Revenue Cycle Director works closely with the Director of Finance, insurance payers to resolve payment discrepancies, and partners with the Outreach Department to explore revenue opportunities. Additionally, this role collaborates with departments such as Clinical, Medical, Nursing, Access, Quality, and IT to ensure alignment with organizational goals, optimize revenue processes, and maintain regulatory compliance.

RESPONSIBILITIES

• Oversee the revenue cycle process with a focus on reporting, key performance indicators (KPIs), and performance metrics to drive decision-making and optimize financial outcomes.
• Utilize KPIs such as Days Sales Outstanding (DSO) and denial rates to develop and maintain comprehensive reports and dashboards, ensuring continuous monitoring of revenue cycle performance.
• Negotiate insurance contracts and Single Case Agreements.
• Partner with the Outreach Department to explore revenue growth opportunities.
• Build and maintain strong relationships with insurance network representatives, proactively addressing payment discrepancies and fostering communication to enhance claims resolution.
• Collaborate with internal teams to ensure compliance with insurance contracts and other regulatory requirements, providing support for billing, coding, and documentation processes.
• Provide insights and recommendations based on payment trends, denial management, and revenue cycle data to improve processes and enhance financial results.
• Prepare and present monthly revenue cycle reports, explaining any variances and providing actionable insights for process improvement.
• Manage the self-pay Accounts Receivable (A/R) by performing account follow-up with discharged patients to ensure timely collections.
• Ensure all functions adhere to company policies, state and federal regulations, and contractual obligations to maintain revenue integrity.
• Support annual audits by collaborating with the Director of Finance and ensuring all revenue cycle processes align with audit standards.
• Participate in strategic planning efforts to integrate revenue cycle improvements into broader organizational initiatives.
• Track scholarship days to ensure compliance with OASAS guidelines.
• Ensure the billing department is knowledgeable about current billing practices, insurance guidelines, and regulatory requirements.
• Oversee the daily operations and workflow of the billing team, ensuring efficient task completion and accurate claims processing.
• Identify inefficiencies in the billing processes and implement changes to improve accuracy, timeliness, and revenue capture.
• Troubleshoot system issues within Kipu, CollaborateMD, and Salesforce, working with the Clinical Systems Administrator to ensure smooth integration and functionality.
• Manage insurance portals and Kipu/CMD user access.
• Collaborate with Patient Access to ensure collection of deductibles, co-pays, and non-covered services at the time of admission.
• Prepare reconsiderations and appeals to payers as needed.
• Review and evaluate payer trends, identifying any issues with claim processing or payment delays.
• Ensure all claims are billed and payments posted before the month-end close.
• Oversee the recoupment and refund request processes, ensuring accuracy and adherence to payer guidelines.
• Explore and coordinate training opportunities for the billing team.
• Ensure compliance with HCPCS, CPT, ICD-10 codes, and facility/professional claim requirements.
• Foster a positive work environment focused on collaboration, continuous improvement, and professional growth.

QUALIFICATIONS AND EXPERIENCE

• Bachelor’s degree in business or related field.
• 3-5 years of experience in medical billing or revenue cycle management, with at least 2 years in a supervisory or leadership role. Healthcare and/or behavioral health required; addiction medicine industry experience preferred.
• Strong leadership and problem-solving skills.
• Strong analytical skills.
• Strong math and accounting skills.
• Strong communication skills.
• Process improvement experience a plus.
• General knowledge of CPT/ICD10, Inpatient Billing and Revenue Codes.
• Knowledge of HIPAA and other relevant healthcare regulations.
• Salesforce and Kipu/CollaborateMD experience a plus.

Job Type: Full-time

Pay: $100,000.00 - $110,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Family leave
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person

Salary : $100,000 - $110,000