Kona Medical Consulting is currently looking for Revenue Cycle Management Director under the California Recovery Center located in Roseville, California.

Below Is The Duty Statement Of The Position

Reports to: CEO

Salary range: $80,000 - $125,000 per year

The Revenue Cycle Management Director for California Recovery Center is responsible for the financial operations related to patient care services. This role involves managing the end-to-end revenue cycle process, including patient VOBs, utilization reviews, billing, coding, claims processing, payment posting, and collections. The individual in this role will work closely with clinical, administrative, and financial teams to ensure efficient and accurate revenue generation and collection.

Key Responsibilities

Revenue Cycle Management

• Develop, implement, and monitor revenue cycle policies and procedures to ensure compliance with industry regulations and best practices.
• Proficient at performing VOBs, submit claims, Utilization Review and do follow-ups. During the first few months, RCM Director will take responsibility of these tasks until suitable tasks are able to be delegated.
• Oversee the entire revenue cycle process, from patient intake to payment collection.
• Analyze revenue cycle data to identify trends, areas for improvement, and opportunities for increased revenue capture.
  
  

Billing and Claims Management

• Spearhead billing and coding to ensure accurate and timely submission of claims to insurance providers.
• Monitor claim rejections and denials, and lead efforts to address and resolve them promptly.
• Ensure that claims are properly submitted for all services rendered.
• Proficiently using electronic medical records systems (Kipu EMR, Kipu CRM) to manage patient data, billing information, and claims processing, as well as other billing and insurance-specific portals and systems, (Collaborate MD, Availity, Zelis, Echo Portal, etc.).
  
  

Verification Of Benefits

• Collects and reviews all patient insurance information needed to complete the benefit verification process.
• Verifies patient-specific and precisely documents specifics for various payer plans including patient coverage, cost-share, and access/provide options according to specific SOPs within an appropriate timeline.
• Use portals and online resources such as Availty to confirm policy status and eligibility.
• Collaborates in obtaining prior authorization, claim appeals, etc.
• Reports disbursement trends/delays to Admissions Team.
• Maintains high quality customer service standards in compliance with federal and state regulations and guidelines. Provide periodic processing status updates.
  
  

Utilization Reviews

• Completes pre-authorization and concurrent reviews for all levels of care in a timely manner.
• Utilize clinical information and knowledge of medical necessity criteria to effectively communicate plans of care to insurance case managers, facility staff, and healthcare partners.
• Collaboration/consults with various members of the multidisciplinary team concerning required information to complete concurrent reviews.
• Manage, improve, and optimize the EMR documentation that contributes to the UR process.
• Ensure all days for each client are authorized timely and appropriately communicated through organization.
• Maintain necessary data for completing reviews and for tracking existing and future reviews.
• Coordinate peer-to-peer review calls with clinic staff and UR representative.
• Prepares and submit Appeal documentation (including rationales) to the appropriate entities as indicated.
  
  

Financial Performance

• Collaborate with finance and accounting teams to reconcile payments, post adjustments, and ensure accurate financial reporting.
• Set and monitor key performance indicators (KPIs) related to revenue generation, billing efficiency, and collection rates.
• Develop strategies to optimize revenue cycle performance and maximize revenue capture.
• Develop real time reporting using Microsoft BI or similar tools.
  
  

Team Management and Development

• Lead and motivate revenue cycle teams, providing guidance, training, and performance evaluations.
• Foster a collaborative and productive work environment that encourages innovation and continuous improvement.
  
  

Compliance and Regulation

• Stay current with industry regulations, payer policies, and coding guidelines to ensure compliance.
• Develop and maintain a strong understanding of behavioral health billing and coding practices specific to the facility's services.
  
  

Technology

• Evaluate and implement revenue cycle software solutions and technologies to streamline processes and enhance efficiency.
• Identify opportunities for automation and process optimization within the revenue cycle.
  
  

Requirements And Qualifications

• Bachelor's degree in healthcare administration, finance, business, or a related field; Master's degree preferred
• Minimum of 10 years of experience in revenue cycle management within a healthcare facility, with specific experience in behavioral health (substance use disorder and mental health) billing preferred.
• Strong knowledge of billing and coding practices, insurance regulations, and industry compliance standards.
• Proficiency in using revenue cycle management software and electronic health record (EHR) systems.
• Excellent leadership, communication, and interpersonal skills.
• Analytical mindset with the ability to interpret data, generate insights, and make data-driven decisions.
• Detail-oriented approach to ensure accuracy in billing and claims processing.
• Experience in managing and developing teams.
• Certified Professional Coder (CPC) or Certified Revenue Cycle Representative (CRCR) certification is a plus.
• Must be willing to report onsite in Roseville, CA.
  
  

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