The Director of Revenue Cycle reports to the VP of Finance and Revenue Operations of Vinfen and is responsible for the billing, collection, and reporting of all third-party insurance revenue of Vinfen Corporation and its affiliate corporations in order to meet the company’s goals of effective revenue cycle management, collections against billed amounts, targeted days of open (uncollected) accounts receivable and the aging of those receivables. The Director of Revenue Cycle Management is responsible for managing the Outpatient Billing and Collections Team, so staff understand all relevant information and develop and implement systems for all sources of revenue. The Director of Revenue Cycle Management ensures the company’s processes produce required documentation to support accurate billing that complies with all private, state, and federal regulations and accounting standards. He or she is also responsible for designing and monitoring documents, systems and training, internal controls, and collaborating with managers of program operations to ensure operations staff produce timely and accurate billing information that complies with pertinent requirements and regulations.

The essential job duties/responsibilities of the position include but are not limited to the information listed below:

• Management oversight of all business-related functions of the Outpatient Billing Team; third-party insurance billing, payment posting, accounts receivable follow-up, payor contracting, clinician rostering and information systems maintenance and the internal controls related to these functions. 
• Develops, monitors, and assesses revenue metrics to refine processes and improve performance, including ensuring all billing is submitted to payers promptly and well within timely filing limits. 
• Regularly provides upper management with revenue/payment status including reports, metrics, and presentations. 
• Oversees maintenance and updates of the relevant module, set-up, and data tables in the electronic health record systems and related billing engines. 
• Directs resolution of billing and payment issues and ensures proper communication to executive and program leadership in accordance with established parameters. 
• Ensures analysis and correction of root causes of denials, billing errors, database errors, etc. that result in non-payment or denied claims. 
• Collaborates with other departments/programs, especially program operations, to design systems, train staff, implement. monitor and implement changes needed to ensure effective and timely revenue workflow. 
• Establishes relationship with key personnel at payer organizations and granting/contracting agencies. 
• Resolves escalated reimbursement issues with payers. 
• Monitors billing regulations and payer requirements for changes; communicates and coordinates implementation of billing regulation and payer requirement changes. Dir Revenue MA Admin 2 • Develops, implements, and maintains Revenue Department standard operating procedures. 
• Hires, trains, and develops assigned staff. 
• Conducts annual performance evaluations for assigned staff, including goal setting and counseling where appropriate. 
• Conducts regularly scheduled meetings with staff to assign tasks and responsibilities, and communicate issues regarding procedures, processes, and overall effectiveness. 
• Ad hoc reports and presentations, as needed. 
• Performs other related duties, as assigned.

Knowledge and Skills:

• 10 or more years’ experience with healthcare revenue cycle processes, Medicare and Medicaid/MassHealth, ACO/MCO and private insurance billing and collections at a medium to large size behavioral health or human services provider organization, hospital, or large specialty provider – OR claims management and processing experience from a behavioral healthcare payer/insurance company 
• Proven healthcare revenue cycle experience - claims billing, collections, and accounts receivable management
• Demonstrated knowledge of health insurance, (behavioral) healthcare payer contracts, clinician rostering requirements and payer fee schedules 
• Experience managing, communicating and negotiating with payers, insurance companies and behavioral health management vendors such as MassHealth, Carelon, Optum, Point32, CCA and others 
• Demonstrable knowledge of claims denial management and denial avoidance procedures 
• Proven management reporting skills 
• Proven experience building teams and driving/implementing process improvement initiatives 
• Excellent internal and external customer service skills
• Strong process and quality orientation 
• Excellent oral and written communication skills and recognize the importance of teamwork 
• Proficiency in Microsoft Office with advanced Excel skills. 
• Experience with systems such as MMIS, eHana, ARPlus/Hill, NetSmart and Waystar

Job Requirements:

• At least ten years’ revenue cycle experience in a complex health care environment with an electronic health record and practice management system.
• Experience with behavioral health claims submission, denial management and systems conversion experience preferred.
• Five to seven years of management experience at manager level required, director level strongly preferred.

Preferred /Required Education:

• Bachelor’s degree in accounting, finance, business administration, or related field required.
• Master’s Degree in accounting, finance, business administration or related field strongly preferred.
• In some instances, experience may be substituted for academic training.
• Certified Medical Coder or Certified Professional Coder designation strongly preferred