Director of Revenue Cycle Management – Behavioral Health
Revive BHS
Revive BHS is seeking an experienced Director of Revenue Cycle Management to lead revenue cycle operations for our growing portfolio of behavioral health clients throughout Maryland. Our clients include substance use disorder treatment programs, Outpatient Mental Health Centers (OMHCs), and other community-based behavioral health providers.
This is a hands-on leadership position for someone with extensive Maryland behavioral health billing experience who understands the full revenue cycle from benefits verification and authorization through claim submission, reconciliation, denial management, collections, and reporting.
The Director of Revenue Cycle Management will oversee client accounts and Revive's billing team, establish and monitor billing workflows, identify reimbursement issues, and ensure our clients are collecting the revenue to which they are entitled. This individual must be comfortable managing multiple organizations, payer mixes, EHR systems, and levels of care simultaneously.
Responsibilities
- Oversee day-to-day revenue cycle operations for a portfolio of Maryland behavioral health clients, including SUD treatment programs, OMHCs, and other behavioral health providers.
- Manage the complete revenue cycle, including verification of benefits, eligibility, authorizations, claim creation and submission, payment posting, reconciliation, denial management, appeals, collections, patient responsibility, and patient statements.
- Provide direct leadership and supervision to billing managers, billing specialists, authorization/VOB staff, and other RCM team members.
- Monitor billing activity and ensure claims are submitted accurately and timely.
- Maintain strong working knowledge of Maryland Medicaid/PBHS billing through Carelon Behavioral Health, including eligibility, authorizations, claims, reimbursement requirements, and provider-specific billing rules.
- Oversee billing and reimbursement for commercial insurance and other applicable payers in addition to Maryland Medicaid.
- Monitor accounts receivable and establish processes for aggressive and timely follow-up on unpaid, underpaid, rejected, and denied claims.
- Review aging reports and identify payer, provider, authorization, coding, documentation, or operational trends affecting collections.
- Develop corrective action plans for accounts experiencing elevated denials, aging A/R, authorization issues, or reimbursement problems.
- Monitor reimbursement against applicable fee schedules and contracted rates and identify underpayments.
- Oversee denial management and payer appeals, including escalation of recurring or systemic payer issues.
- Establish and monitor key performance indicators for each client account, including clean claim rate, denial rate, days in A/R, aging by bucket, collection rate, authorization-related denials, outstanding A/R, and monthly collections.
- Provide regular revenue cycle reporting to Revive leadership and client leadership teams.
- Participate in client meetings and clearly communicate billing performance, identified problems, corrective actions, and recommendations.
- Develop and implement standardized billing workflows, policies, procedures, internal controls, and account-specific processes.
- Assist with onboarding new RCM clients, including EHR and clearinghouse setup, payer configuration, billing matrices, fee schedules, workflows, reporting, and transition from previous billing vendors or internal teams.
- Work collaboratively with Revive's credentialing and consulting teams when enrollment, licensing, credentialing, or operational issues affect reimbursement.
- Ensure billing practices comply with Maryland Medicaid, Carelon, Medicare when applicable, commercial payer requirements, HIPAA, and applicable federal and state regulations.
- Stay current on changes to Maryland behavioral health reimbursement, billing requirements, authorization requirements, payer policies, fee schedules, and coding guidance.
- Recruit, train, supervise, and evaluate RCM staff as the department continues to grow.
- Identify opportunities for automation, improved workflows, and technology utilization to increase efficiency and collections.
- Serve as the primary internal escalation point for complex billing, reimbursement, payer, and revenue cycle issues.
Required Qualifications
- Minimum of 5 years of healthcare revenue cycle management experience, including significant leadership or management responsibility.
- Direct experience with Maryland behavioral health billing is required.
- Strong working knowledge of Maryland Medicaid/PBHS and Carelon Behavioral Health.
- Experience billing for OMHC and/or substance use disorder treatment services.
- Thorough understanding of behavioral health authorizations, eligibility verification, claims submission, payment posting, denials, appeals, collections, and A/R management.
- Experience managing multiple client accounts, locations, programs, or billing entities simultaneously.
- Demonstrated ability to analyze A/R and reimbursement data and translate findings into specific operational improvements.
- Experience supervising and developing billing teams.
- Strong understanding of CPT, HCPCS, ICD-10, modifiers, payer-specific billing requirements, and behavioral health reimbursement methodologies.
- Experience working with behavioral health EHRs, clearinghouses, payer portals, and electronic claims/remittance systems.
- Strong Excel/Google Sheets and reporting skills.
- Excellent written and verbal communication skills.
- Highly organized with the ability to manage competing priorities and deadlines.
- Strong problem-solving skills and the ability to independently research and resolve complex payer and reimbursement issues.
Preferred Qualifications
- Experience with multiple Maryland behavioral health levels of care, including OMHC, IOP, PHP, outpatient SUD, residential SUD, PRP, and other community-based behavioral health services.
- Experience with Carelon, Medicaid EVS, Availity, commercial payer portals, and Maryland-specific behavioral health authorization processes.
- Experience implementing or transitioning EHR and billing systems.
- Experience managing RCM operations for a third-party billing company, consulting organization, or multi-site behavioral health organization.
- CPC, CPB, CRCR or other relevant billing/revenue cycle certification is preferred but not required.
- Bachelor's degree in healthcare administration, business, finance, or a related field preferred; equivalent relevant experience will be considered.
What We're Looking For
This position requires someone who can operate at both the
director and operational level. The right candidate should be capable of reviewing company-wide RCM performance and developing strategy, but also willing and able to get into an individual claim, authorization, ERA, payer portal, or aging report when something isn't making sense.
We are looking for someone who takes ownership of revenue cycle performance rather than simply managing claim submission. This person should be proactive about identifying lost revenue, preventing recurring billing issues, holding the team accountable to performance standards, and ensuring clients receive clear and accurate information about the financial health of their programs.
This is a remote position.