Director, Revenue Cycle And Billing Compliance

Title: Revenue Cycle & Billing Compliance Director 

Unit: Behavioral Health Division 

Reports to: AVP, Behavioral Health Division 

Status: Full-Time  

Location: Long Island City, NY  

Days/Hours: Monday through Friday, 9:00am to 5:00pm (1 day remote) 

Position Summary: 

At the Fortune Society our vision is to foster a world where those who are incarcerated or formerly incarcerated can thrive as positive, contributing members of society. Our Behavioral Health division, which includes an Article 822 OASAS-licensed outpatient treatment services program, an Article 31 OMH mental health outpatient treatment and rehabilitation services center (MHOTRS), and a NYS Health Home Care Management unit, is dedicated to the complex needs of those dealing with the stressors of a criminal justice history and/or recent decarceration. Many of those we serve have cooccurring disorders which are compounded by poverty and homelessness.  

As our housing portfolio and program offerings continue to expand, so does the need for behavioral health services. Therefore, we are seeking an experienced Revenue Cycle and Billing Compliance director with a meticulous eye for detail to join us in this rapid expansion. The candidate will demonstrate a proficiency in creating and facilitating proven strategies that will increase the overall financial performance of the billing practices, accounts receivable, and claim success rates in our outpatient clinic/center. The ideal candidate is a specialist in outpatient clinical claims reimbursement, data analysis and reconciliation, and in achieving annual revenue targets. 

Core Competencies: 

Mission Fit 

We are seeking a candidate with a desire to work with persons impacted by the criminal justice system, and a commitment to using respectful, constructive means of communication when interacting with participants and colleagues. The candidate will utilize a strengths-based, person-centered model and endorse the concept of looking for the best in people, rather than judging them by their worst decision(s).  

Billing Expertise 

The candidate will be an integral member of the management team, responsible for the administrative, financial, and managerial operations of the Billing and Compliance function of our department; managing credentialing for new and existing behavioral health employees; accessing documentation supporting medical service for appropriate billing of the reported service; assessing and monitoring of Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) coding. 

Collaboration 

The ideal candidate will be able to demonstrate the ability to collaborate with other members of the treatment team, with an open-minded approach to differences of opinion and constructive feedback.   

Essential Duties and Responsibilities: 

• Manage and lead auditing and Billing Compliance reviews for the agency’s outpatient treatment services clinic, mental health center (MHOTRS), and care management practice; 

• Routinely analyze accounts receivable and expedite account resolution; identify and resolve trends in payments and resolve trends in denials; recommend corrective action plans when necessary; 

• Maintain fiscal compliance and reconciliation including developing budgets, tracking, and revenue/receivable reporting; routinely review trends in billing with senior management to identify necessary programmatic adjustments; 

• Coordinate, interpret, and monitor the Revenue Cycle of the department, review claim volume and charges, and provide weekly updates to AVP on progress toward monthly billing goals; 

• Manage monthly closing procedures including, but not limited to, reconciling claim rejections with the AR summary and providing a claims revenue trend analysis by clinic; 

• Review and evaluate the effectiveness of internal controls in Fortune’s EHR and practice management system database; document internal processes and work seamlessly with EHR and database vendor(s) to resolve issues; 

• Ensure compliance with all Medicaid policies throughout the department, including compliance with city, state, and federal regulations as well as funder and OMIG guidelines; 

• Work closely with program leadership to ensure service delivery matches compliance requirements to ensure accurate Medicaid and other government revenue billing; 

• Provide concise data and supporting evidence for audit inquiries and insurance credentialing/recredentialing contracts; 

• Work with third party payors to resolve unpaid receivables and serve as liaison between third party payors, medical and clinical staff, and Billing team; 

• Manage the insurance credentialing process for departmental providers; 

• Manage vendor relationship with EHR; 

• Supervise a staff of two; manage staff recruitment, onboarding, training, and day to day activities and scope of work; 

• Provide direction to and training of staff on functional specific tasks, applications, concepts, policies and/or procedures. 

• Assume overall responsibility for the accurate execution of all Behavioral health billing policies and procedures; 

• Assist with special projects including satellite expansion and/or integrated licensure and EHR/vendor selection; 

Qualifications: 

• Bachelor’s degree required; Master’s degree preferred; with significant experience Medicaid and social services billing and proven experience with third party insurance billing policies and procedures; 

• Minimum 3 – 5 years experience in Billing Compliance and Revenue Cycle management with a strong preference for outpatient clinical claims reimbursement experience; 

• Proficiency in Microsoft Suite (Word, Excel, Outlook, Power Point, Access), Medicaid billing software and nonprofit accounting software; 

• Proven track record developing new programs, procedures, protocols that increase billables; 

• Strong leadership and supervisory skills required; 

• Excellent verbal and written communication skills are required 

Physical Demands: 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The responsibilities and requirements listed are representative of the knowledge, skills, minimum education, training, licensing, experience and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.

The Fortune Society is an Equal Opportunity Employer. All qualified applicants will be afforded equal employment opportunities without discrimination because of conviction history, race, religion/creed, color, national origin, sex, age, disability, sexual orientation, gender identity, military status, predisposing genetic characteristics, victim of domestic violence status or marital status. 

IND123