Revive BHS

Director

• Oversee day-to-day revenue cycle operations for a portfolio of Maryland behavioral health clients
• Manage verification of benefits, eligibility, authorizations, claim creation and submission, payment posting, reconciliation, denial management, appeals, collections, patient responsibility, and patient statements
• Lead and supervise billing managers, billing specialists, authorization/VOB staff, and other RCM team members
• Monitor billing activity and ensure accurate, timely claim submission
• Oversee Maryland Medicaid/PBHS, Carelon Behavioral Health, commercial insurance, and other payer billing and reimbursement
• Monitor accounts receivable and follow up on unpaid, underpaid, rejected, and denied claims
• Review aging reports and identify trends affecting collections
• Develop corrective action plans for denials, aging A/R, authorization issues, and reimbursement problems
• Monitor reimbursement against fee schedules and contracted rates and identify underpayments
• Oversee denial management and payer appeals
• Establish and monitor client-account KPIs, including clean claim rate, denial rate, days in A/R, aging, collection rate, authorization-related denials, outstanding A/R, and monthly collections
• Provide regular revenue cycle reporting to Revive and client leadership
• Participate in client meetings and communicate billing performance, problems, corrective actions, and recommendations
• Develop 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 transitions
• Collaborate with credentialing and consulting teams on enrollment, licensing, credentialing, and operational issues
• Ensure compliance with Maryland Medicaid, Carelon, Medicare when applicable, commercial payer requirements, HIPAA, and applicable regulations
• Stay current on Maryland behavioral health reimbursement, billing, authorization, payer, fee schedule, and coding changes
• Recruit, train, supervise, and evaluate RCM staff
• Identify automation, workflow, and technology opportunities to improve efficiency and collections
• Serve as primary internal escalation point for complex billing, reimbursement, payer, and revenue cycle issues

Director of Revenue Cycle Management