Job Title : Director of Revenue Cycle Management (SUD RCM company) Hybrid Remote position; EST preferred General responsibilities: : Oversee the processes of Billing, Utilization Review, Verification of Benefits (VOB), insurance and patient collections, data reporting, insurance contract negotiations, payment posting, bank statement reconciliation, collaborating with financial management team. Oversee team culture, hiring and terminating as needed, aware of company budget, financial success, billing and payment related software management. Departments: VOB, Billing, Collections, UR, HR, Payment posting, Reporting. Reports To : Chief Revenue OfficerLocation: Remote Position Summary: The Director of Revenue Cycle Management (RCM) is responsible for overseeing all aspects of the revenue cycle process in a substance use disorder (SUD) treatment facility, including billing, coding, utilization review (UR), verification of benefits (VOB), insurance and patient collections, payment postings, data reporting. This individual will lead a team of professionals dedicated to ensuring the timely and accurate submission of claims, efficient collection of payments, effective utilization of treatment services, and full compliance with payer requirements, all while aligning with the clinical and financial goals of the organization. The Director will also play an integral role in improving operational efficiency and enhancing the overall financial performance of the organization. Key Responsibilities: 1. Leadership and Strategic Direction: + Lead, mentor, and manage the revenue cycle teams, including billing, coding, utilization review, verification of benefits, AR collections. + Provide direction and oversight in the development and execution of the revenue cycle strategy, ensuring that it supports the overall organizational goals and financial objectives. + Collaborate with senior leadership to establish annual goals, budgeting, and forecasting for the revenue cycle department. + Promote a culture of accountability, excellence, and customer service within the revenue cycle team, ensuring high standards of performance and continuous professional development. + Conduct regular performance reviews, provide feedback, and implement corrective actions where necessary to improve team productivity and performance. + Cultivate strong relationships with clinical, operational, and financial teams to promote a unified approach to revenue cycle operations. 2. Billing and Coding Management: + Oversee the entire billing process, ensuring all patient accounts are accurately billed, following industry standards, payer guidelines, and contractual obligations. + Ensure all claims are coded correctly in compliance with current CPT, ICD-10, and HCPCS codes as well as payer-specific coding rules for substance use treatment services. + Develop and enforce best practices for billing and coding, working closely with coders to ensure accuracy and prevent claim rejections. + Establish and monitor clear guidelines for timely claim submission, aiming for clean claims that minimize the need for rework or resubmission. + Proactively identify and resolve billing discrepancies and provide feedback to clinical and operational teams on improvements in documentation. + Ensure billing is submitted in a timely manner per week. 3. Utilization Review (UR) and Compliance: + Oversee the utilization review process to ensure that patient care is medically necessary and appropriate for the level of service provided. + Develop and maintain standardized criteria for clinical services to align with payer requirements for authorization and reimbursement. + Collaborate with clinical staff to ensure proper documentation of the clinical necessity of treatment, ensuring that all utilization reviews are conducted in a timely manner. + Work with payers to secure prior authorizations for services, addressing issues related to medical necessity, length of stay, and treatment interventions. + Regularly monitor utilization trends and identify opportunities to optimize clinical resources while maximizing reimbursement. + Lead audits and reviews to ensure compliance with regulations and payer requirements, including ensuring that all services provided are covered by the patient’s insurance and meet medical necessity criteria. 4. Verification of Benefits (VOB) and Pre-Authorization: + Direct and oversee the VOB process, ensuring that insurance benefits are accurately verified at the time of intake or prior to service provision. + Develop a standardized approach for obtaining and documenting insurance verification, including eligibility, coverage limits, co-pays, co-insurance, deductibles, and authorization requirements. + Ensure that all necessary pre-authorizations are obtained before delivering specific treatment services, including inpatient or outpatient treatment, detoxification, and therapy services. + Collaborate with the admissions team to ensure accurate intake documentation and the timely collection of patient insurance information. + Track authorization timelines and ensure that pre-authorizations are received on time to prevent service delays or denial of reimbursement. 5. Revenue Cycle Optimization and Performance Improvement: + Continuously evaluate and enhance revenue cycle processes to ensure optimal efficiency, accuracy, and reimbursement. + Monitor key performance indicators (KPIs) such as accounts receivable aging, days in accounts receivable, denial rates, collection rates, and payer mix. + Implement corrective action plans for areas of revenue cycle performance that fall below expectations, identifying root causes and developing targeted solutions. + Utilize data analytics and reporting to identify trends in billing and reimbursement, making data-driven decisions to improve processes and mitigate risks. + Collaborate with other departments to streamline workflows, eliminate bottlenecks, and implement process improvements that enhance revenue cycle performance. 6. Denial Management and Appeals: + Lead the denial management process by reviewing all denied claims, ensuring that appropriate actions are taken to appeal or resolve each denial. + Develop and maintain a comprehensive appeals process for denied claims, ensuring that all necessary documentation and supporting evidence is provided to payers in a timely manner. + Analyze denial trends to identify systemic issues and implement strategies to reduce the frequency of denials. + Educate the billing, coding, and clinical teams on payer-specific requirements to reduce errors and prevent future denials. + Foster strong relationships with payer representatives to negotiate and resolve complex denial issues. 7. Compliance, Regulatory, and Accreditation Oversight: + Ensure that all revenue cycle operations adhere to federal, state, and local regulations, as well as accreditation requirements specific to substance use disorder treatment. + Stay current with changes in healthcare regulations, payer policies, and reimbursement rules that affect substance use treatment billing and reimbursement. + Ensure compliance with federal programs such as Medicare and Medicaid, as well as commercial insurers, by maintaining up-to-date knowledge of billing, coding, and reimbursement guidelines. + Monitor changes in regulations such as 42 CFR Part 2, HIPAA, and other relevant guidelines related to substance use treatment and privacy. + Prepare the organization for audits and accreditation reviews, ensuring all revenue cycle-related documentation and practices are ready for scrutiny. 8. Financial Reporting and Analysis: + Provide regular financial reporting on the revenue cycle’s performance, including metrics such as collections, denial rates, payer mix, and accounts receivable aging, billing, UR, patient balances. + Prepare monthly, quarterly, and annual reports for senior leadership, highlighting the financial health of the organization and providing actionable insights for improvement. + Develop financial forecasts for revenue cycle-related income and expenses, assisting in budgeting and financial planning. + Analyze payer performance to identify opportunities for negotiating better reimbursement rates or terms with insurers. + Collaborate with the CFO and financial team to develop strategies for improving cash flow, reducing bad debt, and increasing revenue. 9. Collaboration and Cross-Departmental Communication: + Collaborate closely with the clinical team to ensure that patient care and billing are aligned, especially in cases requiring complex treatment plans. + Work with intake and admissions staff to ensure that accurate and complete insurance information is captured at the point of service entry. + Serve as the primary point of contact for payers, patients, and internal departments regarding billing inquiries, payment disputes, and claim statuses. + Communicate clearly with staff regarding any changes in payer requirements, billing procedures, or regulatory updates. + Provide education and training for clinical, administrative, and billing staff to ensure understanding of revenue cycle processes and compliance requirements. 10. Collections : + Oversee insurance collections team to ensure constant follow up and outstanding claims are getting remitted within 90 days from the date of billing. + Oversee patient collections team to ensure patient responsibility (deductibles, Copays, coinsurance) are getting collected in a timely manner and set up long term payment plans as needed. 11. Insurance contract negotiations + Submit IN-Network insurance applications as needed + Collaborate with the CRO on payor negotiation process + Provide reporting on INN vs OON payor trends such as average daily billed vs paid report monthly. + . + Experience: + A minimum of 7 years of experience in revenue cycle management, with at least 5 years in a leadership role, preferably in a healthcare or substance use treatment setting. + Extensive knowledge of billing, coding, and reimbursement processes, specifically for substance use disorder treatment services. + Experience with payer contracts, utilization review, and authorization management, with a strong understanding of insurance verification and medical necessity documentation. + Proficiency with healthcare billing software, electronic health records (EHR) systems, and financial management tools. + Strong familiarity with industry standards, including ICD-10, CPT, HCPCS, and other medical coding systems. + Skills: + Strong leadership and interpersonal skills, with the ability to lead and motivate teams. + In-depth understanding of healthcare financial operations, regulatory requirements, and best practices in revenue cycle management. + Proficient in data analysis, financial reporting, and performance metrics. + Excellent problem-solving and critical thinking abilities, with the ability to identify issues and implement solutions in a timely manner. + Superior communication skills, both written and verbal, with the ability to explain complex concepts to non-technical stakeholders. + Strong attention to detail and organizational skills, with the ability to manage multiple projects and priorities. Physical and Environmental Requirements: + Ability to work in an office environment. + Occasional travel may be required for conferences, training, or site visits. + Must be able to sit for extended periods and perform tasks using a computer. This position is pivotal in driving the financial success of a substance use treatment facility by ensuring that the revenue cycle is well-managed, compliant, and optimized for maximum reimbursement. The Director of Revenue Cycle Management will play a critical role in ensuring the financial stability of the organization while maintaining a high standard of care for all patients. EEO Statement: Advanced Revenue Solutions is an Equal Opportunity Employer. We consider all applicants without regard to race, color, national origin, gender, gender identity, sexual orientation, age, disability, veteran status, or any other status protected by law.