Revenue Cycle Director

Center For Mental Health•Great Falls, MT

3d•Hybrid

About The Position

The Revenue Cycle Director will be responsible for maintaining monthly dashboards including KPIs and production numbers. This role involves researching and collaborating on regulation updates to ensure daily workflows incorporate necessary changes. A key responsibility is developing and implementing a double-check process for system postings on a quarterly/monthly basis. The Director will collaborate with the CFO on value-based revenue achievements with key insurers, focusing on performance outcomes and payment analysis for commercial payers, including fee schedules, contracts, and plan offerings. This position oversees the credentialing/provider enrollment process for seamless integration of providers. The role also includes managing the maintenance, updates, and data table setups within electronic health record systems and related billing engines, ensuring billing functions are maintained or added as needed. A critical aspect is the analysis and correction of root causes for denials, billing errors, and database errors that lead to non-payment or denied claims. The Director will collaborate with third-party billing vendors for improved data mining and financial reporting, and with other departments to design systems, train employees, and implement changes for effective revenue workflow. Collaboration extends to front desk employees for billing procedures, insurance, client payments, and petty cash, as well as with the CFO and accounting employees for overall revenue cycle management. The Director will assist the CFO in developing operational strategies to increase cash, reduce bad debt, and decrease client refunds. They will also work with department supervisors on check-in/check-out processes, including education, training, dashboards, scripting, EHR software, and mapping. A significant part of the role involves liaising with the third-party billing vendor, overseeing performance expectations, driving process improvements, and facilitating CPH billing, coding, A/R, and collections. The Director will train, develop, support, and manage staff, fostering a team environment, and adhere to HR/Company policies, including approving timecards and time off. Compliance with all CMS, Federal, and State regulations, payor guidelines, and consistent coding application is mandatory. The role requires regularly providing leadership with revenue/payment data, reports, metrics, and presentations, directing the resolution of billing and payment issues, and ensuring proper communication to leadership. The Director will also resolve escalated reimbursement issues with payers and perform other duties as assigned.

Requirements

Bachelor’s degree in accounting or business-related field required.
Eligibility may be established on the basis of six (6) years’ experience in lieu of a degree.
Minimum three (3) years progressive experience in health care billing field, preferably mental health services.
This experience should include supervisory and/or leadership duties.

Responsibilities

Maintain monthly dashboard including KPIs, production numbers, etc.
Research and collaborate on regulation updates to ensure all necessary changes are incorporated into daily workflows.
Develop double check process for postings to system software on a quarterly/monthly basis.
Collaborate with CFO as it relates to key insurers on value-based revenue achievements as it relates to performance outcomes.
Assist CFO on payment analysis for the various commercial payers as it relates to fee schedules, contracts, and the various plan offerings under each insurance plan.
Manage the credentialing/provider enrollment process to ensure clear integration and alignment for incoming and outgoing providers occurs.
Oversees maintenance, updates of the relevant modules, set-up, and data tables in the electronic health record systems and related billing engines.
Collaborates with the team to ensure billing functions are being maintained or added as necessary in the electronic health record systems.
Ensures analysis and correction of root causes of denials, billing errors, database errors, etc. that result in non-payment or denied claims.
Collaborate with MRWH billing/other vendor(s), if utilized, for improved data mining and financial reporting tools as it relates to revenue cycle.
Collaborates with other departments/programs to design systems, train employees, monitor and implement changes needed to ensure effective and timely revenue workflow.
Collaborates with the front desk employees for billing procedures, insurances, client payments, petty cash, etc.
Working in collaboration with CFO and accounting employees as it relates to revenue cycle management.
Assist CFO in preparing and developing operational strategies to increase cash, reduce bad debt, and decrease client refunds.
Work in collaboration with department supervisors for oversight with check in and out process: education, training, dashboards, scripting, EHR software, mapping, etc.
Liaise with 3rd party billing vendor. Oversee performance expectations and successful process improvements while facilitating/collaborating with 3rd party vendor for CPH billing, coding, A/R, collections, and any other contractual expectations.
Train, develop, support, and manage staff while supporting a team environment.
Adhere to HR/Company policies and procedures, evaluate, and approve timecards and time off requests.
Comply with all CMS, Federal and State regulations, payor guidelines and ensure consistent and compliant coding application.
Regularly provide leadership with revenue/payment data, reports, metrics, and presentations.
Directs resolution of billing and payment issues and ensures proper communication to executive and program leadership in accordance with established parameters.
Resolves escalated reimbursement issues with payers.
Performs other duties as assigned.