Director, Revenue Cycle Management

Responsibilities

• Revenue Cycle Infrastructure Build
• Design and implement end-to-end RCM workflows for a multi-state behavioral health telehealth practice, starting with commercial payer launch in Florida and California
• Select, configure, and own the practice management and billing platform, including integration with the organization's EHR and CRMEstablish clearinghouse relationships, claims submission workflows, and electronic remittance and ERA posting processes
• Develop and maintain the denial management taxonomy, root-cause analysis workflow, and resubmission processes by payer
• Build cash flow forecasting models for the insurance ramp, including DSO assumptions by payer, denial rate benchmarks, and receivables aging
• Credentialing and Payer Enrollment
• Own payer credentialing and enrollment for all providers across target commercial payers in each state, using a credentialing platform such as Medallion or equivalent
• Establish and maintain CAQH profiles for all providers and ensure 90-day attestation cadence is met without lapse
• Manage supervising physician co-credentialing in supervision states, coordinating with the CMO to ensure coverage is in place before claims are submitted
• Track credentialing status, re-credentialing cycles, and payer contract effective dates in a system of record, distinguishing credentialing from contracting as separate workflows
• Behavioral Health Coding and Billing Compliance
• Ensure accurate and defensible use of behavioral health CPT codes: psychiatric evaluation codes (90791, 90792), E/M codes for medication management (99213 through 99215), and add-on psychotherapy codes (90833, 90836, 90838) per AMA guidelines and payer-specific billing rules
• Develop and enforce provider documentation standards supporting submitted codes, including DSM-criterion documentation, validated screening tools (PHQ-9, GAD-7), and telehealth-specific encounter requirements
• Oversee certified coder pre-submission review of all claims, ensuring E/M level accuracy and appropriate ICD-10-CM diagnosis coding
• Monitor OIG Work Plan priorities for behavioral health and telehealth and adjust internal audit protocols accordingly
• Understand and apply MHPAEA (29 CFR Part 2590.712) requirements when appealing disproportionate payer denials or prior authorization practices
• Payer Strategy and Contracting
• Conduct state-level payer analysis identifying the top commercial payers by covered lives and align target payer selection with the organization's insurance launch strategy
• Lead payer contracting conversations in collaboration with the CMO and General Counsel, tracking negotiated rates, contract terms, and effective dates
• Develop and maintain a payer performance dashboard tracking denial rates, DSO, reimbursement rates, and appeals outcomes by payer
• Monitor telehealth billing rules by state and payer, including place-of-service code requirements (POS 02, POS 10) and originating site rules
• Team Build and Provider Education
• Define staffing requirements for the RCM function and lead hiring of billing specialist, medical coder, and coding auditor as volume warrants
• Establish performance standards, workflow accountability, and quality review cadence for direct reports
• Serve as the organization's behavioral health revenue cycle subject matter expert, educating providers and clinical leadership on documentation requirements, coding expectations, and payer-specific rules
• Compliance and Audit Readiness
• Maintain audit-ready credentialing files and claim documentation that can withstand payer, state, or federal review
• Monitor and apply HIPAA (45 CFR Parts 160 and 164), CMS telehealth billing guidance, and, where applicable, 42 CFR Part 2 for substance use disorder patient records
• Coordinate with General Counsel on payer audit responses, RAC audit preparation, and any compliance investigations involving billing or coding practices

Requirements

• Minimum seven years of progressive revenue cycle experience in a behavioral health, psychiatric, or substance use disorder practice or health system environment
• Deep working knowledge of behavioral health CPT coding, including psychiatric evaluation codes, medication management E/M codes, and psychotherapy add-on codes
• Hands-on experience with commercial payer credentialing and enrollment in a multi-provider, multi-state environment
• Practical familiarity with MHPAEA requirements and the application of parity arguments in payer appeals
• Experience selecting and implementing practice management, billing, and clearinghouse platforms in a behavioral health setting
• Strong proficiency in denial management, root-cause analysis, and appeals processes specific to behavioral health payer denials
• Strong working knowledge of HIPAA Privacy and Security Rule requirements as applied to billing and revenue cycle operations
• U.S.-based with a dedicated, HIPAA-appropriate remote workspace
• Would be a plus: Experience in a multi-state telehealth or digital health practice environment, Familiarity with 42 CFR Part 2 and its application to billing and records workflows for substance use disorder treatment, Experience with credentialing platforms such as Medallion, Verifiable, or equivalent, CPC, CCS, or CPMA certification from AAPC or AHIMA, Experience working in a clinically integrated model alongside a CMO or physician leadership team