Director Revenue Cycle Management
hace 2 días
Union
The Director of Revenue Cycle Management owns the full revenue cycle for a fast-growing personal emergency response system (PERS) business. Our billing is high-volume and recurring for a monthly service for a large, active member base billed to Medicaid, Managed Care Organizations (MCOs), and other payors. \n This leader sets the strategy and runs the daily operation for claims submission, denial and rejection resolution, cash posting, A/R and reporting. Success requires deep payor and Medicaid/MCO knowledge, strong command of HME/DME software, RCM workflows, and the ability to build a team and a set of controls that keep recurring claims clean at scale. \n \n Responsibilities \n \n Strategy & Leadership \n\n • Develop and execute the revenue cycle strategy for PERS recurring billing, aligned with corporate financial goals and growth plans.\n, • Lead, coach and hold accountable the RCM Team Leads and staff across billing, A/R, denials, cash posting and payor portal administration.\n, • Set clear production standards, quality targets and daily operating rhythms for a high-volume team.\n\n \n Recurring Claims and Operations \n\n • Own accurate, timely, on-schedule submission of recurring monthly claims (electronic, paper and portal-based), including rental and service cycle management in Brightree and Office Ally.\n, • Serve as the business owner of Brightree billing configuration: payor setup, billing rules, claim scrubbing edits, recurring-billing runs, ERA/835 auto-posting, reports and user roles. Partner with IT and Brightree on upgrades, enhancements and issue escalation.\n, • Manage clearinghouse relationships and claim-status tools, and drive automation to reduce manual touches per claim.\n\n \n Authorizations and eligibility \n\n • Oversee the authorization and reauthorization process so that recurring services stay covered without gaps, working with intake, operations and payor partners.\n, • Ensure eligibility verification and member-status changes are caught before they turn into denials or write-offs.\n\n \n Denials, rejections and A/R \n\n • Lead denial and rejection resolution: set strategy, ensure daily follow-up, and drive root-cause remediation back to the source (intake, documentation, authorization, billing setup).\n, • Monitor A/R aging, timely filing exposure, appeals and write-offs; run initiatives to reduce aging and improve cash flow.\n, • Track denial trends by payor, plan and denial code, and bring findings and fixes to payors and internal teams.\n\n \n Cash, reconciliation and reporting \n\n • Partner with the Controller and accounting team to reconcile payments and ensure accurate posting of all insurance, partner-pay, ERA/EOB, EFT and non-automated payments.\n, • Review and approve refund and overpayment requests, and ensure posting, deposits and remittances are complete, accurate and on time.\n, • Build and present the KPI package to leadership: clean claim rate, first-pass acceptance, days in A/R, collection rate, denial rate and cash forecast variance.\n\n \n Payors, compliance and process \n\n • Manage payor portal administration, including user access, credentials and compliance, and maintain payor relationships with Medicaid agencies, MCOs and Medicare Advantage plans.\n, • Ensure compliance with payor contracts, state Medicaid rules, HIPAA and applicable DME billing requirements; support audits and payor reviews.\n, • Drive continuous process improvement across billing, collections, denial management, reporting and automation.\n\n \n Qualifications \n \n\n • 7+ years of revenue cycle experience, including 3+ years leading a billing or collections team in a high-volume environment.\n, • Hands-on experience with Brightree (or a comparable DME/HME billing and rental system) and recurring or rental billing cycles.\n, • Deep knowledge of Medicaid reimbursement, state regulatory requirements, and MCO/SNP contract and billing rules.\n, • Working knowledge of ICD-10 and HCPCS coding and CMS-1500 professional claim submission.\n, • Demonstrated success reducing denials and rejections, shortening A/R days and improving clean claim rates.\n, • Experience with authorization and reauthorization workflows, ERA/835 posting and EFT reconciliation.\n, • Strong team management skills, including performance management, training and workflow oversight.\n, • Advanced Excel skills (VLOOKUP/XLOOKUP, pivot tables, SUMIF, macros) and comfort with BI and reporting tools.\n, • Experience applying automation and AI tools to revenue cycle work (for example claim-status automation, AI-assisted denial analysis, coding or documentation review, and workflow bots), with sound judgment on accuracy, human review and PHI/HIPAA safeguards.\n, • Ability to evaluate AI and automation opportunities, build the business case, pilot them with the team and measure results.\n, • Excellent analytical and problem-solving skills, with clear written and verbal communication.\n\n \n How Success is Measured \n\n • Clean claim rate and first-pass acceptance rate on recurring billing runs\n, • Days in A/R and percentage of A/R over 90 days\n, • Denial rate by payor, and time to resolve denials\n, • Net collection rate and cash versus forecast\n\n \n Compensation \n The anticipated base salary range for this position is $125,000-175,000, depending on experience, skills, and other job-related factors. This position is bonus eligible. \n \n We are committed to a diverse and inclusive workforce, one that reflects the varied communities we serve. The services we offer and the products we build greatly benefit from a range of perspectives, which can only come from diversity of all types at all levels of the organization. Achieving true diversity and inclusion is the right thing to do and is also the smart thing for our business. We strongly encourage women, veterans, people with disabilities, people of color and gender nonconforming candidates to apply. \n We are an Equal Opportunity Employer and does not discriminate on the basis of an individual's sex, age, race, color, creed, national origin, alienage, religion, marital status, pregnancy, sexual orientation, gender identity and expression, disability, genetic trait or predisposition, carrier status, citizenship, veteran or military status and other personal characteristics protected by law. All applications will receive consideration for employment without regard to legally protected characteristics. \n