The Director of Revenue Cycle Management is the senior leader accountable for the end-to-end revenue cycle. Reporting to the Executive Director of Finance, this role owns the people, process, technology, and vendor strategy that converts clinical care into accurate, timely, and fully reimbursed revenue.
Duties/Responsibilities:
- Build, lead, and develop high-performing Patient Accounts and Utilization Review teams, fostering a culture of patient-centered service, financial integrity, and continuous improvement.
- Develop and execute a multi-year RCM strategy aligned with clinical growth, payer mix, and length-of-stay dynamics across hospital and residential services.
- Own enterprise RCM KPIs and drive performance improvement across all functions.
- Partner with Finance on monthly close, A/R reserves, bad debt methodology, and net revenue forecasting; deliver executive and board-level reporting.
- Oversee patient access operations (pre-admission through registration), ensuring accurate data capture, insurance verification, financial counseling, and point-of-service collections.
- Lead authorization and utilization review across all levels of care; defend level-of-care decisions and reduce denied and avoidable days.
- Ensure record integrity, chart completion, release of information, and compliance with HIPAA and 42 CFR Part 2 requirements.
- Direct coding and build a Clinical Documentation Improvement program to drive accuracy, compliance, and optimal reimbursement.
- Own Charge Description Master governance, including coding, pricing, and regulatory requirements.
- Oversee billing and claims operations, including payment posting and reimbursement processes.
- Improve clean claim rate and first-pass yield through process improvements.
- Lead denials, appeals, and revenue recovery efforts using data-driven insights and accountability across teams.
- Oversee insurance follow-up, self-pay collections, payment plans, financial assistance, and bad debt placement.
- Partner with managed care on contract strategy, modeling, negotiations, and payer performance.
- Oversee RCM vendors, systems, and partner with IT on technology optimization (including EHR integration and automation).
- Ensure compliance with all applicable federal and state regulations and accreditation standards; lead internal and external audits.
- Perform other duties and responsibilities as assigned.
Required Skills/Abilities:
- Must have the ability to function optimally in a stressful environment, and the ability to remain calm in emotionally charged situations.
- Strong working knowledge of behavioral health and residential treatment reimbursement required.
- Demonstrated expertise in regulatory requirements including 42 CFR Part 2, HIPAA, MHPAEA, and the No Surprises Act required.
- Familiarity with the Connecticut payer landscape, including Anthem, Cigna, Aetna, UnitedHealthcare/Optum Behavioral Health, ConnectiCare, HUSKY Health, and TRICARE East preferred.
Education and Experience:
- Bachelor's degree in Healthcare Administration, Business, Finance, or related field preferred.
- Minimum of 10+ years of progressive revenue cycle experience required, including at least 5 years in leadership across revenue cycle management (RCM) functions.
- Proven track record of measurable improvement in core RCM KPIs and leading process and/or technology change initiatives required.
- Experience managing third-party RCM vendors and outsourced functions required.
- Experience with Meditech and FinThrive systems preferred.
- Prior leadership experience in a behavioral health hospital, psychiatric facility, or residential treatment/SUD provider preferred.
- Relevant professional certifications such as CRCR, CHFP, FHFMA, RHIA, RHIT, CCS, or CPC preferred.
Physical Requirements:
- Prolonged periods sitting at a desk and working on a computer.
- Must be able to lift up to 15 pounds at times.
Pay Transparency:
- Salary range: $175,000 - $210,000
- Overtime eligible: Exempt
