Director of Revenue Cycle Management- Denver

FloodGate Medical•Tampa, FL

45d•Hybrid

About The Position

A fast-growing and high-impact startup that makes smart beds for children with cognitive conditions like Epilepsy, Cerebral Palsy, Dementia and Autism. Our mission is to improve the lives of special needs kids and their families through our innovative products and go-to-market strategies. Since launch, we have changed the lives of thousands of families, been insurance covered in all 50 states, achieved profitability, and are building a growing team in our Denver HQ. Role Overview The Director of Revenue Cycle Management is responsible for overseeing the revenue cycle of the new DME organization, including medical necessity documentation, coding, billing, collections, and denial management as well as financial reporting. This position is responsible for building the RCM function, ensuring claims, denials, and appeals are efficiently processed and for resolving billing-related issues. The Director of RCM will minimize bad debt, improve cash flow, and effectively manage accounts receivable. Additionally, this person will be responsible for managing policies and operating requirements, including document collection for proof of delivery and installation. This role requires a detailed understanding of healthcare reimbursement systems: coverage policies, fee schedules, medical necessity documentation, prior approval processes, and appeals of denied coverage. An analytical mindset and strong oral and written communication skills are required. You will be the first dedicated employee of this new DME, helping to improve access to life-changing medical devices for special needs families across the country. This role will partner closely with our COO, CFO, CEO, and VP of Growth and has the potential for significant growth.

Requirements

5+ years’ experience involving healthcare insurance plan claims review and payment (Medicaid, CHIP, commercial and managed care companies, Medicare, and other third-party payers).
Experience in securing funding of specialized medical equipment.
Understanding of healthcare insurance plan operations to include coverage policies, fee schedules, medical review, prior approvals, appeals of denied coverage, and payer network operations.
Ability to effectively develop and present information supporting coverage of specialty medical equipment at the time of initial coverage request and through any appeals of denied coverage.
Ability to effectively develop and monitor billing, collection, and accounts receivable reports and analyses.
Strong interpersonal and collaboration skills; ability to develop effective working relationships with both internal and external customers.
Excellent oral and written communication skills.
Excellent organizational skills and ability to manage multiple projects simultaneously.
Proactive, self-motivated, and curious by nature.

Nice To Haves

Startup experience is preferred but not required. Those with an entrepreneurial spirit!
Bachelor’s degree in business, healthcare, or related field.
Prior experience with process development and execution.
Knowledge of managed care organizations and integrated healthcare systems.
Tech savvy and able to quickly adapt to new software and workflows.

Responsibilities

Oversee all billing and collection activities, ensuring accurate billing to healthcare insurance plans and customers.
Assist families, medical professionals, DME providers, and others in navigating the channels to secure funding (includes medical necessity documentation, fee schedules, initial submissions, prior approvals, and appeals of denied coverage). This may be directly or via partnership with other patient teams.
Develop, monitor, and present reports on billing, collection, and accounts receivable activity.
Coordinate monthly closing processes, including reporting and account balancing.
Document and resolve healthcare insurance plan billing denials.
Evaluate and continuously improve billing processes and procedures.
Collaborate internally with the team to ensure alignment of messaging and to maximize funding success.
Ensure activities are conducted in compliance with Federal, State, and payer regulations, guidelines, and requirements.
Engage in strategic projects with cross-functional teams as needed.
Manage policies and operating requirements, including document collection for proof of delivery and installation.
Collaborate in building and revising processes related to billing, collections, patient experience, etc.