Revenue Cycle Manager

Revenue Cycle Manager

MAIN FUNCTION

The Revenue Cycle Manager is responsible for overseeing and optimizing all aspects of the revenue cycle for Heartland Counseling Services, Inc. (HCS). This position ensures accurate and timely billing, effective accounts receivable management, appropriate reimbursement, and compliance with federal, state, and payer-specific requirements.

The Revenue Cycle Manager provides leadership and supervision to the billing department, develops strategies to maximize revenue collection, reduces claim denials, and identifies opportunities to improve operational efficiency.

Working closely with the Vice President of Finance, clinical leadership, and program directors, the Revenue Cycle Manager plays a critical role in maintaining the financial health and sustainability of HCS while supporting its mission of providing accessible, high-quality behavioral health services.

DUTIES & RESPONSIBILITIES

Revenue Cycle Management

• Oversee the complete revenue cycle, including charge capture, claims submission, payment posting, denial management, accounts receivable, and collections.
• Ensure timely and accurate billing for mental health, substance use disorder, psychiatric, crisis, community-based, and other reimbursable services.
• Monitor revenue-cycle performance and identify opportunities to increase collections and reduce revenue loss.
• Develop, implement, and maintain standardized billing procedures across HCS programs.
• Identify and resolve billing inefficiencies, reimbursement discrepancies, and operational barriers.
• Monitor unbilled services and work with clinical leadership to address documentation or workflow issues that delay reimbursement.

Billing Department Leadership

• Directly supervise, train, mentor, and evaluate billing department employees.
• Establish performance expectations and monitor individual and departmental productivity.
• Coordinate workloads, assignments, and coverage to ensure efficient department operations.
• Provide ongoing education regarding billing regulations, payer requirements, and procedural changes.
• Foster a collaborative, accountable, and solutions-focused work environment.
• Participate in hiring, onboarding, performance evaluations, and corrective action processes in coordination with Human Resources and the Vice President of Finance.

Accounts Receivable and Collections

• Monitor accounts receivable aging and develop strategies to reduce outstanding balances.
• Oversee follow-up on unpaid, underpaid, rejected, and denied claims.
• Establish processes for timely appeals and resolution of outstanding claims.
• Analyze payer payment patterns and identify reimbursement delays or systemic issues.
• Coordinate with payers to resolve complex claims and payment disputes.
• Provide regular accounts receivable reports and recommendations to the Vice President of Finance.

Payer Relations and Reimbursement

• Serve as a primary point of contact for billing and reimbursement issues involving Medicaid, Medicare, managed care organizations, and commercial insurance carriers.
• Maintain knowledge of payer contracts, fee schedules, billing requirements, and reimbursement methodologies.
• Monitor changes in payer policies and communicate necessary updates to affected departments.
• Identify payment discrepancies and ensure reimbursement aligns with applicable contracts and regulations.
• Coordinate provider enrollment, credentialing, and payer revalidation processes with designated HCS personnel.
• Support resolution of payer enrollment and authorization issues that impact reimbursement.

CCBHC and Specialized Behavioral Health Billing

• Oversee billing processes associated with HCS's Certified Community Behavioral Health Clinic (CCBHC) services.
• Maintain working knowledge of Nebraska Medicaid CCBHC reimbursement requirements, including the Prospective Payment System (PPS).
• Monitor CCBHC claims, payment accuracy, and reimbursement discrepancies.
• Coordinate with clinical and program leadership to ensure appropriate documentation, service coding, and billing practices.
• Support the development and implementation of billing processes for new programs and services, including crisis stabilization, withdrawal management, and other expanded behavioral health services.
• Monitor changes in state and federal behavioral health reimbursement requirements.

Compliance and Quality Assurance

• Ensure billing practices comply with applicable federal and state laws, Medicaid and Medicare regulations, payer contracts, and organizational policies.
• Develop and maintain internal billing quality assurance processes.
• Conduct routine billing audits to identify coding errors, documentation concerns, and potential compliance risks.
• Coordinate with HCS compliance and quality improvement personnel regarding billing-related findings.
• Ensure appropriate processes exist for identifying, reporting, and resolving overpayments and billing errors.
• Maintain confidentiality of protected health information in accordance with HIPAA and organizational requirements.

Electronic Health Records and Technology

• Maintain a strong working knowledge of HCS's electronic health record and billing systems, including Credible.
• Collaborate with clinical leadership, IT, and designated system administrators to improve billing workflows and reporting capabilities.
• Identify opportunities to automate processes, reduce manual work, and improve billing accuracy.
• Assist with implementation and testing of billing-related system updates.
• Ensure billing data is accurate, complete, and accessible for financial analysis.

Financial Reporting and Performance Improvement

• Develop and maintain a monthly revenue-cycle dashboard for the Vice President of Finance.
• Monitor key performance indicators, including:
• Accounts receivable aging and days in AR
• Clean claim submission rate
• Claim denial and rejection rates
• Collection rates
• Unbilled services
• Outstanding payer balances
• Claim turnaround times
• Write-offs and adjustments
• Payer reimbursement discrepancies
• Analyze trends and provide recommendations to improve financial performance.
• Collaborate with the Vice President of Finance on revenue forecasting and identification of reimbursement risks.
• Participate in organizational performance improvement initiatives and relevant leadership meetings.

The revenue cycle manager may perform other related duties as assigned by the Vice President of Finance

REQUIRED SKILLS & ABILITIES

• Demonstrate accountability, professionalism, and ethical decision-making.
• Lead employees through clear expectations, constructive feedback, and ongoing professional development.
• Take initiative in identifying and resolving revenue-cycle challenges.
• Maintain a proactive approach to collections and reimbursement issues.
• Build positive working relationships with clinical, administrative, and executive leadership.
• Demonstrate a commitment to continuous improvement and financial stewardship.
• Support the mission, vision, values, and strategic goals of Heartland Counseling Services.

EDUCATION & EXPERIENCE

Minimum Qualifications

• Associate's degree in accounting, finance, business administration, healthcare administration, or a related field, or equivalent relevant experience.
• Minimum of three years of healthcare billing, revenue cycle, or accounts receivable experience.
• Demonstrated knowledge of Medicaid, Medicare, and commercial insurance billing.
• Experience with claims management, denials, collections, and reimbursement processes.
• Strong analytical, organizational, and problem-solving skills.
• Ability to interpret financial and billing reports.
• Proficiency with electronic health records, billing software, and Microsoft Excel.
• Strong communication skills and the ability to collaborate across departments.
• Ability to maintain confidentiality and exercise sound professional judgment.

Preferred Qualifications

• Bachelor's degree in business administration, finance, accounting, healthcare administration, or a related field.
• Three to five years of progressively responsible revenue-cycle experience.
• Previous supervisory or management experience.
• Experience in behavioral health, mental health, substance use disorder treatment, or community health settings.
• Knowledge of CCBHC reimbursement, Medicaid PPS, or federally funded healthcare programs.
• Experience with Nebraska Medicaid and managed care organizations.
• Familiarity with Credible or comparable behavioral health electronic health record systems.
• Professional certification in healthcare revenue cycle, billing, or coding, such as CRCR, CPB, or CPC.

PHYSICAL REQUIREMENTS

• Prolonged periods of sitting at a desk and working on a computer
• Must be able to lift up to 15 pounds at times.