Revenue Cycle Director

4 weeks ago

Santa Fe, United States Santa Fe Recovery Center, Inc Full time
Job DescriptionJob DescriptionDescription:

Santa Fe Recovery Center is a leading provider of substance use disorder and mental health treatment and education services. We are looking for a full-time Revenue Director to join our team at our Santa Fe offices. We offer a competitive salary (BOE) and the Benefits shown below. Experience working in the Healthcare Industry and/or Non-Profit is highly preferred. This is a great opportunity to continue to advance in your career while being part of the team that is providing support to the community.


Revenue Cycle Director Benefits:

  • A generous PTO package (3 weeks of PTO, 7 paid holidays, 3 floating holidays, & 2 mental health days)
  • Medical, Dental, and Vision insurance (90% to 100% premium covered by employer)
  • ST and LT disability
  • Pet insurance
  • Opt-in 401k with 4% match
  • Access to our comprehensive Employee Assistance Program, providing 24/7/365 access to a licensed professional for staff and their immediate families

Summary:

The Revenue Cycle Director is responsible for overseeing and managing the entire revenue cycle process for the organization’s fee-for-service business. This includes Billing and Coding, Patient Access, Medical Records, and Utilization Review. The Revenue Cycle Director will manage and optimize all facets of revenue cycle operations to ensure staff compliance with all applicable policies and procedures.

Duties and Responsibilities of the Revenue Cycle Director: (Included but not limited to)

You'll report to the CFO and:

  • Direct oversight and management of all the Santa Fe Recover Center’s billing operations by monitoring the day-to-day functions including coding, charge entry, claims filing, payor accounts receivable follow-up, denials, collections, bad debt monitoring, and troubleshooting issues.
  • Responsible for ensuring proper and timely credentialing of providers in accordance with applicable requirements.
  • Responsible for reviewing insurance payments for accuracy according to contract terms.
  • Participates in payor contract negotiations, revisions, and addendums.
  • Design and enforce all policies and procedures relating to internal and external revenue cycle operations to ensure efficiency and quality of work.
  • Develop billing policies around MAT, SUD (Substance Use Disorder) Treatment, Behavioral Health (including Psychiatry) specialty programming for adults, children, and adolescents, as well as Physical Health to ensure accurate billing and reimbursement for services rendered.
  • Work closely with the Compliance team to ensure documentation, coding, and billing quality compliance meets statutory requirements.
  • Drive strategy and development of financial support programs for clients.
  • Established as a resident subject matter expert on behavioral health billing.
  • Act as primary liaison and decision maker for matters related to revenue cycle vendors.
  • Work collaboratively with leaders from other departments to effectively create and enforce related policies and procedures.
  • Serves as a liaison between clinical and financial staff.
  • Ensure that metrics are established to produce timely KPI reports for vendor assessment and for management information.

Supervisory Responsibilities:

  • Performance supervision, mentoring staff development, and overall supervision of Medical Records, Patient Admissions/Intake, Utilization Review, Billing, and Coding functions. Carry out supervisory responsibilities in accordance with the organization's policies and applicable laws.
  • Responsibilities include the management of communication with vendors, developing policies related to vendor workflows, reviewing regular reports and monitoring KPIs (Key Performance Indicators), and collaboratively troubleshooting any issues as they arise.
  • Work with other leaders in the organization to develop best practice revenue cycle processes from intake, documentation, charge capture, billing, and collection.
Requirements:

Minimum Requirements:


Skills/Knowledge/Abilities:

  1. Deep familiarity/expertise with related Medicare and Medicaid regulations specific to those for New Mexico
  2. Expertise in medical coding for behavioral healthcare and substance use treatment
  3. Familiarity with CCBHC, its care model, and its associated enhanced billing rates
  4. Experience with InSync or other Qualifacts practice management products is strongly preferred
  5. Deep familiarity with payer/insurance medical policy, Prior Authorizations, claims, appeals, and reimbursement processes
  6. Superior organization skills, detail-oriented, and ability to manage projects through completion

Education and Experience:

  1. 7+ years of required experience in Behavioral Health medical billing, including Medicaid, Medicare, and Tricare
  2. 3+ years payor contracting experience
  3. Must have and maintain a current, valid NM driver's license. Must also have and maintain a clean driving record, as well as auto insurance.

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