Director of Revenue Cycle

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.

Summary of Position:

As the Revenue Cycle Director at Klarisana, you will be responsible for overseeing all aspects of billing and revenue cycle management for the clinics and business, including Klarisana and clinician credentialing, patient registration, patient insurance verification to final payment. You are responsible for ensuring Klarisana is paid timely and accurately for the services we provide. You will develop strategies for measuring, planning and improving the revenue cycle to maximize revenue, ensure compliance, and optimize financial performance. You will be responsible for the financial health of the organization and reporting on KPIs. You will lead a team of billing professionals, develop and implement billing strategies, policies, and procedures, ensure compliance with relevant regulations, and negotiate contracts with insurance companies. Klarisana has proactively implemented technology solutions including our EHR and certain agentic AI solutions to automate several RCM processes. This role is crucial in maintaining the financial health of the clinics and supporting our mission of providing high-quality care to our patients and providing a patient journey that is consistently highly rated by our patients.

Responsibilities:

Billing Operations Management:

• 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.

Provider and insurance credentialing:

• 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

Team Leadership:

• 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.

Revenue Cycle Optimization:

• 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.

Claims Processing and Compliance:

• 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.

Financial Analysis and Reporting:

• 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.

Payer & Employer Relations:

• 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.

Training and Education:

• Provide ongoing training and education to staff on billing processes, coding guidelines, and regulatory changes.
• Ensure staff compliance with billing policies and procedures.

Qualifications:

• Bachelor's degree in Healthcare Administration, Business Administration, or a related field or relevant experience.
• 6-8 years of experience in healthcare billing and revenue cycle management, with 3 years in a leadership role.
• Strong knowledge of healthcare billing practices, insurance regulations, and reimbursement processes.
• Proficiency in medical billing software and electronic health records (EHR) systems.
• Successfully negotiated with payers to improve contracts and increase reimbursements.
• Experience implementing and utilizing AI in revenue cycle functions.
• Excellent leadership, communication, and interpersonal skills.
• Ability to analyze data, identify trends, and make data-driven decisions.
• Certified Professional Biller (CPB) or Certified Revenue Cycle Professional (CRCP) certification is a plus.

WORK ENVIRONMENT

Hybrid, office setting

TRAVEL REQUIREMENTS

Commuting to and from office/clinic locations.

Klarisana is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Our goal is to be a diverse workforce that is representative, at all job levels, of the people we serve.

Job Type: Full-time

Pay: $120,000.00 - $150,000.00 per year

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Paid time off
• Vision insurance

Work Location: Hybrid remote in San Antonio, TX 78240

Salary : $120,000 - $150,000