The Revenue Cycle Management Manager is responsible for the overall financial health of the agency, by managing the prior authorization, credentialing, and billing processes to ensure the timely submission of claims to insurance companies and accurate reimbursement for behavioral healthcare and primary care services provided. They will work closely with healthcare providers, insurance companies, and other stakeholders to ensure compliance with regulatory standards.

Responsibilities:

1. Oversee a team responsible for various aspects of revenue cycle management, including billing, coding, collections, and claims processing. Provide leadership, guidance, and training to ensure staff proficiency and adherence to best practices.
2. Assigns for completion and/or ensures the completion of department key functions, including:
3. Eligibility/Insurance Verification
4. Process of claims submission
5. Payment posting and processing
6. Deposits
7. Prior Authorization
8. Service and change error correction
9. Client statements
10. Denial management/aging
11. Continuously assess and improve revenue cycle processes to enhance efficiency, accuracy, and revenue optimization. Identify bottlenecks, inefficiencies, and areas for improvement, and implement solutions to streamline workflows.
12. Stay up-to-date with relevant laws, regulations, and industry standards governing billing and reimbursement in behavioral health. Ensure compliance with HIPAA, Medicare, Medicaid, and other regulatory requirements to avoid penalties and mitigate risks.
13. Analyze revenue cycle metrics, such as days in accounts receivable (AR), denial rates, and clean claim rates, to monitor performance and identify trends. Generate reports and insights to inform decision-making and drive improvements in revenue cycle performance.
14. Oversee the submission and processing of claims to insurance payers, ensuring accuracy and timely reimbursement. Monitor claim status, follow up on denials and rejections, and implement strategies to minimize claim rejections and maximize collections.
15. Ensure proper coding of behavioral health services in compliance with coding guidelines (e.g., ICD-10, CPT) to facilitate accurate reimbursement. Provide coding education and training to staff to ensure coding accuracy and compliance.
16. Manage billing operations, including charge capture, claim generation, and payment posting. Implement billing best practices to accelerate revenue cycle processes and reduce revenue leakage.
17. Maintain revenue integrity by identifying and addressing issues related to charge capture, coding errors, unbilled services, and other factors that may impact revenue realization.
18. Develop and implement denial management strategies to reduce the volume and impact of claim denials. Analyze denial trends, identify root causes, and implement corrective actions to prevent future denials.
19. Oversee relationships with third-party vendors, such as billing software vendors and clearinghouses, to ensure smooth operations and effective utilization of technology solutions.
20. Collaborate with patient financial services to address patient billing inquiries, establish payment plans, and facilitate financial assistance programs to support patients in managing their healthcare expenses.
21. Provide ongoing training and professional development opportunities to revenue cycle staff to enhance their skills, knowledge, and performance.

Requirements:

• Preferred: Certified Revenue Cycle Representative (CRCR), Certified Professional Biller (CPB) Certification, Certified Professional Coder (CPC) Certification, Certified Billing and Coding Specialist (CBCS) Certification.

Education:

• Preferred: Associates or Bachelors degree in Healthcare Administration from an accredited college or university.

Experience:

• Preferred: Minimum of 3 years of revenue cycle management experience and a strong understanding of the credentialing, prior-authorization, and insurance reimbursement processes.
• Experience in the Behavioral Health, Primary Care, and SUD treatment field.

By effectively managing these responsibilities, a Behavioral Health RCM Manager contributes to the financial viability and sustainability of the organization while ensuring the delivery of high-quality care to patients.