Director of Revenue Cycle Management (RCM)

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Job description

Overview:
Position Summary: The Director of Revenue Cycle Management (RCM) is responsible for the execution and day-to-day management of all revenue cycle functions. This includes the direct oversight of accounts receivable collection efforts of the organization and for reducing bad debt associated with collection experience. This role will oversee payor billing, payor collections, patient responsibility management, contracting, credentialing, cash posting, and insurance verification. Working under the direction of the VP of RCM, this role will be responsible for executing all initiatives, system changes, and process improvements for the RCM team.

Why choose Behavioral Innovations:

Daily Pay: Access your pay when you need it!

Wellbeing Program: Equipping you with tools to achieve your wellness goals.

OVIA Health: A Women's Health App supporting you throughout the entire Parenthood Journey.

Employee Assistance Program (EAP): Comprehensive support for your mental, emotional, and physical health.

Supportive Team Structure: Our clients and families are our top priority, and we foster a collaborative and expert team environment.

Additional Programs Offered at BI: ABA Intern, Referral Bonuses, Employee Recognition, Employee Perks.

Career Advancement Opportunities: Ongoing training & Professional development for all employees.

Insurance: Medical, Vision, Dental, and Supplemental Insurance Policies.

University Partnerships: Enjoy tuition rate discounts.

Pet Insurance!

Duties & Responsibilities:

Revenue Cycle Management

Hire, train and supervise the entire revenue cycle function to ensure timely billing and collection for all third-party payer contracts.

Partner with the Senior Vice President of Outreach & Patient Access, Senior Director of Business Optimization, and Regional Directors of Operations to ensure proper processes are in place between the RCM teams and other functions of the organization to reduce denials and increase Authorizations and RCM teams to reduce and eliminate authorization related denials.

Partner with the Senior Director of Marketing to ensure that clients receive periodic messaging regarding their insurance benefits eligibility and any changes to payor processes that would impact coverage.

Ensure that claims payments are posted accurately to all client accounts and uncollectible receivables are appropriately written off.

Ensure all payor and patient credits are reviewed and appropriately resolved. Responsible for development of proper escheatment processes for any overpayments in line with applicable state and federal laws and regulations.

Develop and oversee the Company's patient responsibility collection strategies, vendor relationships, and processes to improve overall collection rate and client experience.

Monitor denials and aging of receivables to identify problems and take corrective action in a timely manner.

Coordinate and leverage third-party vendors and relationships to meet business objectives.

Credentialing

Identify and implement ways to reduce the time to obtain credentials with newly hired clinical staff.

Develop metrics and reporting to understand and communicate changes in credentialing timelines to the Chief Operating Officer and Regional Directors of Operations.

Ensure the timely re-credentialing of staff when required.

Responsible for integrating new locations into the Company's revenue cycle function.

Insurance Verification

Oversee all aspects of the insurance verification process, including ABA therapy and Diagnostic Services verifications. Partner with the Senior Vice President of Outreach & Patient to ensure efficient processes are in place between the intake and verification teams to ensure timely and accurate results.

Oversee the beginning of year benefits reset process to ensure proper benefits reverification and associated authorizations can be obtained timely.

Audit and Compliance

Maintain confidentiality in compliance with HIPAA regulations.

Partner with the Senior Director of Business Optimization to design audit processes to ensure claims billing accuracy.

Responsible for developing subject matter expertise in CPT code and payor requirements for all services delivered at the organization.

Responsible for developing detailed policies and procedures to hold internal teams, both within RCM and at our centers, accountable for complying with the organization's best practices and regulatory requirements.

Responsible for complying with all federal, state and local regulatory agency requirements.

Ensure compliance with all internal and external controls, payor requirements, regulatory requirements, policies, and procedures across all areas of revenue cycle.

General Duties and Responsibilities

Ensure RCM team and relevant center staff are trained in RCM policies and procedures.

Establish individual performance objectives (KPIs) to measure and improve performance.

Establish billing performance metrics around collection rates, denial rates, and rejection rates and develop a reporting process to track and drive team performance.

Identify performance improvement opportunities and design new processes that are scalable across the organization.

Demonstrates sound judgement and a high level of integrity; displays willingness and ability to make tough decisions.

Ensures patient satisfaction is achieved through courteous and effective communication, problem-solving and efficient processes.

Assists and participates in the company's revenue growth objectives.

Develops written procedures for the centralization and standardization of the revenue cycle; continually monitors changes in workflow as needed to improve productivity.

Establishes and maintains appropriate routine interactions to remain informed of potential pitfalls in a timely manner and escalate appropriately.

Establishes measurable goals for the RCM function and monitors and appropriately adjusts throughout the year.

Assists with other duties as assigned.

Professional:

Demonstrating cultural values: Caring, Accountable, Collaborative, and Family-Focused. Adherence to policies and procedures (Code of Conduct, HIPAA, documentation standards, etc.).

Requirements:

Bachelor's Degree in Business, Health Administration, Public Health or related discipline

A Master's Degree in Health Care, Public Health or Business Administration is preferred.

Minimum of 10 years' professional RCM experience

Minimum of 3 years' experience managing and leading a team of RCM professionals

Experience and expertise in building and maintaining RCM KPIs and dashboards required.

Experience using EMRs (Central Reach preferred)

Experience using Healthcare Clearinghouses (Waystar preferred)

Expert level in RCM processes

Strong organizational skills

Ability to work effectively in a fast-paced environment

Strong team building, leadership skills and personal drive

Strong analytical skills in root cause analysis and problem-solving

Upholding Integrity, Excellence, and the Heart of ABA: For over 22 years, Behavioral Innovations has been providing center-based, evidence-based ABA Therapy across Texas, Oklahoma, and Colorado. Our Culture of excellence, teamwork, and care is guided by our core values and mission. Join us in making a positive impact on the lives of children diagnosed with autism and other developmental disorders. At Behavioral Innovations (BI), our values drive us every day. Recognized with the Clinical Excellence Award in 2021, crowned Company of the Year in 2022, and listed on the prestigious Inc. 5000, we are proud to be one of America's Fastest Growing Private Companies.

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