Billing & Revenue Cycle Director

About Klarisana:

At Klarisana, we are dedicated to providing personalized mental health care for individuals who have not found success with traditional treatments. Utilizing innovative psychedelic therapies with different forms of ketamine treatment we help our patients understand and integrate their past experiences to foster true healing. We walk side by side with our patients through a personalized journey that allows them to reconnect with their sense of self and a more peaceful and balanced perception of the world around them. Our safe and proven treatments have empowered thousands of people to overcome their challenges and focus on a brighter future and healthier mindset. Klarisana is one of the oldest and most experienced ketamine providers in the country.

Responsibilities:

1. Billing Operations Management:

2. • Oversee all eligibility and prior authorization functions so as to ensure patients that are being scheduled have been cleared for appropriate insurance and authorization. 

   • Oversee all billing operations, including claim submission, denial processing and review, payment posting, and accounts receivable management.

   • Develop and implement efficient billing processes and procedures to optimize revenue cycle management.

   • Stay ahead of and prepare for billing changes from regulatory updates, private payer updates, and government payer updates.

   • Communicate with and manage relevant vendors for billing/revenue cycle.

3. Provider and insurance credentialing

4. • Facilitate, manage, and monitor provider and group credentialing to be in network with relevant providers based on current and future growth plans and service offerings.

5. Team Leadership:

6. • Lead and manage a team of billing specialists, providing guidance, training, and support to ensure team effectiveness and productivity.

   • Set performance goals and objectives for the billing team and monitor performance metrics.

7. Revenue Cycle Optimization:

8. • Utilize AI to create efficiencies and optimize revenue cycle operations.

   • Ensure we are registering and scheduling our patients accurately and efficiently.

   • Identify opportunities to improve revenue cycle performance and streamline billing processes.

   • Implement strategies to reduce eligibility questions, denials, optimize collections, and minimize revenue leakage.

9. Claims Processing and Compliance:

10. • Ensure timely and accurate submission of insurance claims and patient statements.

    • Stay updated on insurance regulations and billing requirements to ensure compliance with billing standards and regulations, including HIPAA.

11. Financial Analysis and Reporting:

12. • Create a performance scorecard that reflects appropriate performance indicators such as insurance eligibility, prior authorizations, service to claims days, claims to remittance days and denial rates by plan.

    • Analyze billing data and financial reports to monitor revenue performance and identify trends or areas for improvement.

    • Prepare and present financial reports to leadership, providing insights and recommendations for revenue optimization.

13. Payer Relations:

14. • Build and maintain positive relationships with healthcare payers to facilitate smooth billing processes and resolve billing-related issues.

    • Engage and negotiate with payers for improved contracts.

    • Lead/support efforts to build partnerships with employers to offer Klarisana in their employee assistance programs.

15. Training and Education:

16. • Provide ongoing training and education to staff on billing processes, coding guidelines, and regulatory changes.

    • Ensure staff compliance with billing policies and procedures.