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BestCare Treatment Services, Inc. · 2 days ago

Director of Revenue Cycle Management

Redmond, OR

Full-time

Onsite

Director/Executive

$104K/yr - $136K/yr

10+ years exp

BestCare Treatment Services, Inc. is seeking a Director of Revenue Cycle Management to provide strategic leadership and operational oversight for all revenue cycle activities across their behavioral health and substance use disorder treatment programs. This role is responsible for maximizing reimbursement and cash flow while ensuring compliance with applicable regulations and fostering collaborative relationships with stakeholders.

GamblingHealth CareMental HealthNon ProfitRehabilitation

Responsibilities

Develop and execute a strategic vision for the RCM department that aligns with the organization's overall financial goals and mission, serve as a strategic advisor to the CFO and leadership team on revenue cycle developments and trends in the larger payer environment

Assess and respond to current and future trends in behavioral health reimbursement, particularly focusing on the changing payer environment and the shift towards value-based care models, to ensure the organization's financial stability

Establish and maintain departmental policies, procedures, budgets, and work standards for all revenue cycle functions

Regularly prepare and present revenue cycle performance metrics, initiatives, and issue resolutions to leadership

Analyze the impact of new payment models, such as value-based contracts and alternative payment models (APMs), on the organization's revenue cycle

Identify, assess, and mitigate financial risks associated with evolving reimbursement structures, including potential penalties for not meeting outcome benchmarks in value-based care arrangements

Develop and implement strategies to ensure the organization is positioned to succeed under new payment methodologies, leveraging data and technology to manage performance

Stay abreast of legislative changes and policy updates impacting behavioral health reimbursement, such as enhanced payments for integrated care or crisis services

Oversee the end-to-end revenue cycle process, including patient registration, eligibility verification, coding, billing, payment posting, collections, and denial management

Develop and monitor key performance indicators (KPIs) such as Days in Accounts Receivable, Denial Rate, Clean Claim Rate, and Cash as a Percentage of Net Revenue to drive continuous improvement

Implement strategies to improve revenue capture, optimize cash flow, and reduce claim denials and rejections

Identify opportunities for process improvements and leverage technology to enhance efficiency and effectiveness across all revenue cycle functions

Conduct regular internal audits of revenue cycle processes to ensure accuracy and compliance, adapting to the complexities introduced by value-based care and APMs

Ensure all billing and collection activities are in strict compliance with federal, state, and HIPAA regulations, as well as payer contracts and new payment model requirements

Serve as a primary liaison between the RCM team and clinical, administrative, and finance departments to ensure accurate documentation, coding, and billing practices

Partner with operational teams to proactively identify and resolve issues that impact reimbursement and to ensure smooth RCM workflows. Serve as internal RCM expert and work cross-functionally on process improvements, project implementations and reporting. This includes collaborating with Contracting, Operations, Clinical Management, Finance, Learning and Development

Manage relationships and negotiate contracts with insurance carriers and other third-party payers to ensure favorable reimbursement rates and alignment with new payment models

Collaborate with clinical teams to support the utilization review process and ensure appropriate service authorization and reimbursement

Lead, mentor, and supervise the RCM team, fostering a culture of accountability, collaboration, and continuous improvement

Set clear performance goals and expectations for the team and conduct performance evaluations to ensure staff development

Provide training and continuing education to leadership and staff on industry best practices, regulatory changes, and evolving payer requirements, particularly those related to new payment models and risk management

Qualification

RCM leadership experienceBillingCoding practicesEHR systems proficiencyData analytics toolsValue-based care knowledgeRegulatory knowledgeContract negotiationPerformance evaluationTrainingEducationChange managementFinancial data interpretationStakeholder relationship buildingAudit complianceProcess improvementCommunication skillsProblem-solving skillsOrganizational skillsInterpersonal skillsTeam managementCollaboration skills

Required

Bachelor's degree in business, Finance, Healthcare Administration, or a related field

10+ years of progressive RCM leadership experience, including 5+ years in a leadership role, preferable within a behavioral health or SUD treatment setting

Extensive knowledge of billing and coding practices specific to behavioral health services, including CPT, ICD-10, and revenue codes, capitated payment models, and familiarity with value-based care metrics and documentation requirements

Strong analytical, organizational, and problem-solving skills, with the ability to interpret complex financial data and KPIs, as well as analyze risk within changing payment models

Proven ability to lead, develop, and manage high-performing teams, and drive change management initiatives related to RCM transformation

Proficiency with electronic health record (EHR) systems and RCM software, including tools for data analytics and automation; Epic experience preferred

Excellent communication, interpersonal, and collaboration skills, with the ability to build effective relationships with diverse stakeholders, including clinicians, leadership, and payers

Relevant professional certifications (e.g., CRCE, CHFP) are highly desirable