Director of Revenue Cycle Management

Salary: $125,000 - $130,000/year

Position Summary:

Reporting to the VP, Health & Wellness (HW), the Director will establish and monitor effective claims management processes and controls to ensure the accuracy and timeliness of claims submissions, collection efforts, denial management, and revenue recognition. This system wide process will include the review/monitoring of patient access (prior authorizations and registration), health information management, billing, coding, regulatory compliance, and accounts receivable management. They will supervise the Billing Unit and work in collaboration with the VP Health & Wellness and Health & Wellness Deputies to identify, develop, and execute process improvement initiatives to drive best practice performance and favorably impact net revenue.

Essential Duties:

• Develop, implement, and monitor effective policies and procedures to ensure effective revenue cycle management.
• Collaborate with the Vice President of Health & Wellness and Health & Wellness Deputies to design, implement, and monitor key performance indicators (KPIs) for revenue cycle operations.
• Provide timely, data-driven insights and strategic guidance to divisional and senior leadership to support informed decision-making, optimize program revenue, and ensure financial sustainability.
• Cultivate and manage relationships with insurers/managed-care providers, regulatory agencies, internal stakeholders, and external partners to facilitate streamlined operational processes.
• Working in collaboration with Information Technology, Finance, clinic, and billing staff to ensure seamless billing, problem solve challenges and employ timely solutions.
• Prepare comprehensive revenue projections with a primary focus on Medicaid and managed care programs; regularly reconcile projected versus actual collections and lead investigation and resolution of variances and revenue anomalies.
• Develop and deliver accurate, timely revenue and receivables reports for divisional senior leadership and program managers.
• Partner closely with Agency Fiscal staff to ensure appropriate revenue recognition, accurate receivable recording, and compliance with established accounting standards.
• Establish and oversee methodologies for cash-receipt recording to ensure integrity, consistency, and audit readiness of agency financial records.
• Responsible for developing, reviewing, and editing divisional billing policies and procedures to ensure accuracy, compliance, and operational efficiency.
• In collaboration with the CWFS Foster Care Administration, assure that all aspects of Foster Care program revenue (Medicaid per diem) are accurate and appropriate.
• Review and negotiate contracts with managed care organizations and commercial insurers.
• Supervise and monitor the credentialing process.
• Comply with all privacy laws including HIPAA, etc.
• Other duties as assigned.

Minimum Qualifications:

• Bachelor's degree required.
• Minimum 5 years of experience supervising medical billing staff. Family planning, primary care, and behavioral health experience preferred.
• Demonstrated experience managing Medicaid and commercial billing at scale.
• Hands-on experience with Electronic Health Record (EHR) and practice management systems; eClinicalWorks (eCW) experience preferred.
• Advanced Excel proficiency

Key Competencies:

• In depth knowledge and understanding of:
  
  
  
  • Revenue cycle management principles.
  • Medicaid and managed care guidelines.
  • Medical insurance policies and procedures.
  • EDI institutional and professional claims formats, denial management and appeals.
  • Medical billing and terminology, coding, and collections.
  • Payer enrollment/credentialing.
  
  
  
  
• Proven leader with the ability to set team goals and prioritize daily operations and projects.
• Collaborative manager with strong written, oral, interpersonal, and organizational skills.
• Revenue cycle certification preferred

It is the policy of Children's Aid to provide equal employment opportunity to all employees and applicants for employment and is dedicated to maintaining a work environment that is free from harassment and discrimination. Children's Aid will not tolerate discrimination, harassment, or retaliation on any basis, including race, creed, color, national origin, ethnicity, alienage or citizenship status, gender/sex (including pregnancy), disability, religion, source of income, sexual orientation, gender identity or expression, age, familial status, caregiver status, military status, marital or partnership status, status as a victim of domestic violence, sexual violence or stalking, predisposing genetic characteristics, arrest or conviction record, credit history, unemployment status or any other characteristic protected by federal, state or local law. Children's Aid is committed to complying with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Children's Aid will conduct a prompt and thorough investigation of all allegations of discrimination, harassment, retaliation, or any violation of the Equal Employment Opportunity Policy in a confidential manner and will take appropriate corrective action, if and where warranted. Children's Aid prohibits retaliation against employees who provide information about, complain about, or assist in the investigation of any complaint of discrimination or violation of the Equal Employment Opportunity Policy.

The incumbent is expected to work a schedule, whether in-person or hybrid, as determined by the department's needs to facilitate effective collaboration with the team. This flexibility is essential for maintaining seamless communication, fostering teamwork, and ensuring the smooth operation of the department's processes. The position's requirements are subject to periodic review and adjustment based on organizational needs and changes in work dynamics.

Leader - Inspires teammates to follow them
Functional Expert - Considered a thought leader on a subject

Ability to Make an Impact - Inspired to perform well by the ability to contribute to the success of a project or the organization

Bachelors (required)

3 - 5 years: Hands-on experience with Electronic Health Record (EBR) and practice management systems. (required)
3 - 5 years: Demonstrated experience managing Medicaid and commercial billing at scale (required)
5 - 7 years: Experience supervising medical billing staff. Family planning, primary care, and behavioral health experience preferred. (required)

Skills