Director of Revenue Cycle

Caron Treatment Centers•Wernersville, PA

6h•Onsite

About The Position

Join a purpose-driven team at Caron Treatment Centers, where for nearly 70 years, we’ve been helping people find a path to recovery from addiction and rebuild their lives. We offer real careers with real opportunities for growth, comprehensive training, and a commitment to work-life balance. We’re proud to foster a diverse and inclusive environment, with a culture of teamwork, compassion, and dedication to our mission. Start a career that saves lives at a company that values yours!

Requirements

High school diploma or equivalent required.
5+ years of experience in billing management in a healthcare setting required.
3+ years of supervisory/management experience required.
Demonstrated experience with Medicaid managed care, commercial insurance, and Medicare Part B billing in a behavioral health context.
EHR billing experience required.
Must be able to lift up to 25 pounds.
Will need to sit, stand and type for extended periods of time.
Strong technical knowledge and proficiency with electronic billing management systems, EHR-integrated workflows, clearinghouse platforms, and ERA/835 reconciliation.
Solid process engineering and process improvement skills, including oversight of department reorganizations, billing system conversions, and system upgrades.
Third-party contract negotiation, implementation, and monitoring, including managed care/MCO agreements and proper billing practices.
Strong denial management expertise, including root cause analysis, appeals workflow design, and tracking of controllable write-off recovery.
Authorization and utilization review oversight in a behavioral health or SUD environment.
Credentialing coordination and provider enrollment knowledge.
Strong problem resolution skills with a focus on systemic issues and the ability to discern the need for escalation.
Detail-oriented with the ability to identify the big picture.
Ability to lead, mentor, encourage, and discipline staff at all levels.
Superior communication skills; able to effectively relate to staff, colleagues, senior management, patients, families, and third-party entities.
Advanced financial, computer, and data analysis skills, including report writing and dashboard development.
Regulatory compliance knowledge: HIPAA, 42 CFR Part 2, state Medicaid billing rules.

Nice To Haves

Bachelor’s degree in business, Health Administration, or related field preferred; equivalent professional experience considered.
Behavioral health, substance use disorder, and/or mental health services strongly preferred.
Familiarity with ASAM criteria and the relationship between clinical documentation, authorization, and reimbursement.
Experience with behavioral health-specific platforms preferred.
If in recovery, 1 year of continuous sobriety is preferred.

Responsibilities

Oversee and ensure that all components of the Revenue Cycle are functioning effectively and efficiently, including claims submission, payment posting, denial management, and collections.
Ensure that the Department achieves all goals and objectives established by Senior Leadership, specifically those related to Accounts Receivable, Cash Management, and KPI benchmarks.
Supervise and monitor the performance of the key individuals responsible for day-to-day Revenue Cycle operations.
Serve as source of advice and guidance to all revenue cycle staff as issues, problems, and concerns are escalated.
Ensure that the Controller/CFO is kept informed on a regular basis of the overall status of the revenue cycle, with timely escalation of material issues.
Lead all department staff in providing superior service to all customers of the organization, both external and internal.
Exercise sound judgment in making financial decisions on behalf of the organization related to the revenue cycle process.
Oversee electronic billing systems and EHR-integrated billing workflows, clearinghouse management, and ERA/835 reconciliation; partner with IT to ensure maximum efficiency.
Ensure all third-party reimbursement contracts and managed care/MCO agreements are adequately maintained, monitored, and that the organization is receiving accurate payment per contract terms.
Confirm the integrity of all elements of the revenue cycle database and maintain a firm understanding of their meaning and operational significance.
Assist the Finance Department and Senior Management with preparing and analyzing revenue cycle reports to support sound business decisions.
Lead denial management and appeals processes, tracking root causes of denials, implementing corrective workflows, and monitoring appeal success rates on controllable write-offs.
Oversee authorization and utilization review coordination, ensuring prior authorization workflows are timely and accurate to minimize revenue leakage.
Oversee credentialing coordination in partnership with relevant departments to ensure provider enrollment supports billing readiness.
Build and maintain the reporting infrastructure required to produce KPI dashboards and performance metrics; responsible for solving data availability gaps, not only consuming existing reports.
Represent the Revenue Cycle Management Department in all system initiatives and projects that further the overall mission and goals of the organization.
Work professionally, cooperatively, and creatively with counterparts in all internal departments to improve and enhance processes and procedures.
Prepare and communicate annual performance evaluations for key positions and serve as a mentor to staff in the development of both technical and leadership skills.
Verify and ensure proper segregation of duties and adequate internal controls are in place for all revenue cycle functions.
Ensure staff adherence to department policies and procedures and maintain a current, relevant policy manual.
Ensure all revenue cycle processes comply with applicable regulatory guidelines including HIPAA, 42 CFR Part 2, state-specific Medicaid billing rules, and industry standards.