Revenue Cycle Management- Director

The RCM Director is responsible for leading and owning the full revenue cycle management function with the goal of maximizing net collections, protecting revenue integrity, and ensuring financial sustainability across Clean Recovery Centers’ service lines. This position has direct ownership of billing, collections, denial management, contracting, credentialing, aged accounts receivable, payer trend analysis, compliance, reporting, and operational improvement. The RCM Director sets strategy, leads staff, and is accountable for the performance of the revenue cycle as a whole.

• Own and lead the full revenue cycle function, including billing, collections, denial management, credentialing, contracting, and aged AR, with accountability for outcomes reported directly to the CFO.

• Develop and execute a denial prevention and appeals strategy; track denial root causes by payer and service line and implement corrective action plans to reduce denial rates over time.
• Lead, onboard, and develop RCM staff including collectors and billing personnel; set KPI expectations, provide ongoing coaching, and manage performance.
• Build, analyze, and present RCM reporting to the CFO and executive team, including net collection rates, A/R aging, denial rates, clean claim rates, and payer trend summaries.
• Work a defined number of claims per facility weekly to maintain current knowledge of payer behavior and support staff on complex cases.
• Identify, propose, and execute action plans to improve collections, resolve billing gaps, and address payer-specific issues across all service lines.
• Lead contracting strategy and payer negotiations; manage the credentialing process across facilities and payers; escalate significant terms to the CFO for final approval.
• Ensure compliance with payer contracts, HIPAA billing requirements, CMS/Medicaid rules, and behavioral health-specific billing regulations; maintain current knowledge of OIG guidance relevant to the organization’s service lines.
• Collaborate with the Utilization Review Director to ensure timely and complete medical record submission, authorization accuracy, and documentation quality that supports billing.
• Educate facility staff on billing criteria, medical necessity documentation, insurance requirements, and authorization processes.
• Hold monthly performance meetings with facility leadership to review collection rates, payer issues, and operational priorities.
•  
• Track and report staff productivity, collection rates, billing rates, and other KPIs weekly and monthly to the CFO and executive team.
• Evaluate and optimize RCM technology, including billing software, clearinghouse performance, and AR management tools; recommend improvements to the CFO.
• Attend executive leadership meetings prepared with financial data, project status updates, and forward-looking analysis.
• Maintain professional communication, confidentiality, regulatory compliance, and accurate documentation in all duties performed.

Bachelor’s degree in healthcare administration or related field preferred.

Proven experience in Revenue Cycle Management, healthcare billing and coding processes, claims collection, denial management, payer communication, reporting, and staff leadership.

Relevant certifications in Revenue Cycle Management, such as CRCR or CHFP, preferred.

Strong leadership, management, communication, interpersonal, analytical, reporting, problem-solving, and organizational skills. Proficiency in billing software and Microsoft Office products. Ability to manage client relationships, review performance trends, identify payer issues, support staff, and operate with responsible autonomy.

Knowledge of behavioral health treatment billing, insurance requirements, medical necessity documentation, facility communication, credentialing, contracting, and payer escalation processes preferred.