Director of Finance and Operations, Care Management
Revenue Cycle & Billing Operations
Oversee end-to-end revenue cycle operations for care management services, including eligibility verification, claims submission, payment posting, and reconciliation.
Supervise billing staff and external billing vendors; set productivity standards, performance metrics, and quality benchmarks.
Ensure timely and accurate claim submission through NYS eMedNY, MAPP HHTS, and Managed Care Organization (MCO) portals.
Compliance & Auditing
Maintain compliance with NYSDOH Health Home guidelines, including Health Home Plus (HH+) criteria, community-based mental health assessments, and CMA/MCO contractual requirements.
Lead internal billing audits, prepare for external audits, and implement corrective action plans as needed.
Stay current on Medicaid, Medicare, and state regulatory changes; translate updates into operational policy.
Denial & A/R Management
Track and report on key performance indicators including Days in A/R, denial rates, clean claim rates, and net collection rate.
Lead the appeals process for denied or underpaid claims and identify root causes to reduce future denials.
Build dashboards and regular reporting for executive leadership and the board.
Financial Management
Partner with the CFO and finance team on budgeting, forecasting, and cash flow management.
Oversee accounts payable, accounts receivable, and month-end close activities related to program operations.
Analyze program-level financial performance and recommend strategies to improve margins and reimbursement.
Operations & Cross-Functional Leadership
Partner with Clinical Directors, Care Management Agencies (CMAs), and MCOs to optimize clinical documentation, member enrollment, and billing workflows.
Manage relationships with EHR and billing system vendors; lead system optimization and implementation projects.
Develop and document standard operating procedures across finance and operations functions.
Hire, mentor, and develop a high-performing team.