Director of Revenue Cycle Management - Lightfully Behavioral Health

Job Summary:

The Director of Revenue Cycle Management (DRCM) is responsible for oversight of the revenue cycle functions at Lightfully. This person oversees payor relations including strategy development, contract negotiations, contract implementation, and contract management with third party payors. The DCRM is also responsible for planning, developing and leading RCM processes with a view to maximizing revenues received from all payors and patients for all services and optimizing utilization and patient access to care.

The DRCM, as a member of the Revenue Cycle Team, is responsible for managing support to the Admissions, Utilization, and facility departments to ensure the accuracy and quality of data through upstream and downstream data channels. The DCRM will be responsible for policy and procedure development in all areas of revenue cycle in coordination with the CFO and must have a high-level of integrity and a strong compliance focus.  RCM oversight includes facility (and professional, as applicable) patient and insurance billing and collections activities including ensuring complete and accurate charge capture, verifying appropriate coding and documentation of services, monitoring, and favorably resolving claims, rejections and denials, ensuring timely and accurate payment posting, and managing effective account receivable follow-up. The DRCM will also be responsible facilitating proper revenue recognition and reconciliation with Finance, as well as establishing adequate reserves and owning overall revenue cycle integrity.

This position oversees the Utilization Review Department and ensures that program guidelines are followed under all insurance network contracts, federal and state insurance commissions, as well as all accrediting bodies for all LBH locations. This position also oversees the Medical Records Department, which includes managing medical record requests, chart reviews, and the EMR.

Major Responsibilities:

• Upholds and maintains the Company, mission, and values (called the Lightfully "Shining Commitments").
• Provide supervision, support and coaching to employees. Other management activities include (but are not limited to):
  • Interviewing, hiring, goal development, onboarding and ensuring continuous training requirements and compliance items are met.
  • 1:1 and team meetings to discuss successes, challenges, new projects, innovations, company changes, etc.
  • Timely coaching and disciplinary action (delivery and documentation), as needed
  • Completing performance reviews for employees within company designated timeframes
  • Maintain employees' timecards in the Payroll system, ensuring the correct hours are accounted for, overtime is managed, and paid-time off requests are promptly addressed.
• Oversees the operations of the Revenue Cycle Management department.
• Ensures that all necessary payor contracts are in place with payors to maximize patient access and ensures the contracts with payors support optimized revenue capture.
• Develops strategies relative to payor contracts for maximizing occupancy and leveraging rates by clearly communicating value proposition to payors and communicating current payor status at each facility by maintaining participation calendars and working closely with admissions on placement of patients and UR to maintain authorization.
• Develops, implements, and maintains all policies and procedures related to patient financial services in conjunction with stakeholders and with CFO and Compliance.
• Develops tools and workstreams around patient collections both upfront, payment plans, and balances, including collection agency and creates forms, authorizations and protocols for patient responsibility which clearly communicates obligations to patients and families.
• Develops out-of-network payor strategies to maximize access for patients and utilization, including utilizing Single Contract Agreements (SCA's) and Out of Network billing.
• Develops, implements, and maintains all policies and procedures related to RCM, including patient financial policies for charity care and hardship as well as payment plans.
• Oversees credentialing of facilities and providers with payors maintaining master schedule and verification of recredentialing (if external).
• Clearly defines, establishes, and communicates revenue cycle performance expectations to staff and/or vendors to achieve goals in the areas of patient access, health information management as it relates to billing and coding, rapid and complete collections, and customer satisfaction.
• Anticipates and prepares for upcoming legislation and other external factors that may affect company's RCM function. Effectively communicates this information to key stakeholders.
• Ensures team is adequately trained and prepared to meet today's demands as well as the future demands of an evolving healthcare regulatory landscape.
• Ensure accurate and timely billing and collection of all revenue.
• Develops systems and strategies for the UR department to improve efficiency and quality.
• Monitors updates in medical necessity criteria to ensure programs are meeting insurance requirements.
• Develop control structures within a simple environment to ensure the accuracy and quality of data through all upstream and downstream data channels.
• Provide thought leadership and participate with projects that involve any of the upstream or downstream data flows and processes.
• Ensure controls are in place over applications to ensure the data integrity by performing data integrity gap analysis and coordinating the resolution of data integrity gaps.
• Collaborate with all departments to gather and understand functional requirements, develop complex queries and provide reports.
• Oversee and support the daily operations of all PFS functions, including billing, follow-up and collections, and cash posting.
• Work closely with other departments to streamline procedures that will help ensure correct billing to patients and payers in a timely manner.
• Develops and maintains internal controls to target revenue recovery throughout the organization by identifying charge capture, coding, and reimbursement problems, then implementing solutions.
• Monitors daily productions of claims, denials, and appeals.
• Prepare receivable and revenue information for the monthly and annual general ledger closings.
• Establish a regularly scheduled revenue cycle reports deck for upper management.
• Other duties, as assigned.

Specific Skills/Competencies:

• Excellent management and supervisory skills.
• Excellent organizational and time management skills.
• Excellent written and verbal communication skills.
• Intermediate facilitation skills with the ability to drive issues to closure.
• Self-motivated and able to handle tasks with minimal supervision or questions.
• Ability to deliver a high level of customer service.
• Ability to write various documents such as functional requirements.
• Ability to compare technologies and make recommendations to senior members of the team.
• Understanding of privacy laws and regulations.
• Proficient in Microsoft Office Suite or similar software.
• Experience in credentialing new sites and navigating new contracts with payors in new markets (Emphasis in CA and behavioral health), preferred.
• Ability to read, analyze and interpret financial reports, contracts, and other legal documents.
• Ability to speak English fluently is a requirement.
• Proficient in EHR/EMR and RCM software; experience with KIPU preferred.
• Strong analytical and time management skills.

Physical Requirements

• Must have the ability to communicate with individuals over phone, electronic correspondence, and in-person.
• Ability to type and use a computer frequently.
• Able to work for prolonged periods sitting at a desk and working on a computer.

Mental/Social Requirements:

• Must be able to demonstrate working effectively with and showing respect to all clients/patients and staff, including those from diverse ethnic, cultural, religious, socioeconomic, sexual preferences and/or identities, gender identities/expression, and political backgrounds.
• Must demonstrate ability of solving problems independently, using best judgment and critical thinking skills.
• Must maintain a positive, friendly, and welcoming attitude with staff and clients at all LBH facilities and within the organization.
• Must utilize professional communication when addressing issues with clients or staff.
Other Information
• Must pass extensive background check.
• This is a remote position and requires the ability to perform all duties and responsibilities at home.

Qualifications:

• Bachelor's degree in business, healthcare management, finance, or related field.
• 5+ years of related experience; 2+ years of managerial experience.
• Project management experience with systems migration, implementation and automation procedures, preferred.

The salary range for this position is $110,000-$125,000 annually.