Director of Revenue Cycle Management
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Job Description
Remote RCM Director leading billing operations for Maryland behavioral health providers. Managing payer reimbursement, denials, collections, reporting, and billing teams for Revive BHS.
Responsibilities:
- 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
Requirements:
- 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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