Associate VP of Revenue Cycle Management

Position Title: Associate Vice President of Revenue Cycle Management

FLSA Classification: Exempt

Location: Central Office

Position Type: Full Time

Reports to: Chief Financial Officer

EEOC Classification: First Level Manager/Middle Level Manager

Summary:

The Associate Vice President of Revenue Cycle Management is responsible for overseeing the authorization, utilization, and coordination of NSO services to ensure clients receive appropriate care while maintaining compliance with funding requirements and best practices. This role works closely with the Accounting Operations Manager to link the operations of the revenue cycle seamlessly with the operations of the accounting department for all types of transactions.

Responsibilities:

Funder Compliance and Relationships

• Schedule Work to meet funder time frames and standards.
• Ensures that all service data entered and reported meets funder requirements and adheres to federal, state, and Medicaid regulations.
• Attend funder meetings and Michigan Association of Reimbursement Officers training courses.
• Chairs revenue cycle committee, including charter review annually, data analysis and strategy development to improve outcomes, based on benchmarks.

Service Authorization & Review

• Evaluate and approve behavioral health service requests based on medical necessity, client needs, and funding source guidelines.
• Ensure that services align with individualized treatment plans (IPOS) and regulatory requirements.
• Communicate authorization decisions with providers and care teams.

Utilization Monitoring & Compliance: Reviews and ensures accurate documentation for clinical staff, including individualized plans of service and person-centered plans.

• Track service utilization to ensure alignment with approved authorizations and care plans.
• Conduct periodic utilization reviews and audits to identify service gaps, overutilization, or underutilization.
• Ensure compliance with Medicaid, state, and local community mental health (CMH) policies and guidelines.

Collaboration to Ensure Care Delivery:

• Work closely with case managers, therapists, and other providers to ensure necessary care is authorized and reimbursed as applicable by laws.
• Assist in resolving authorization issues, denials, and appeals as needed.
• Provide guidance on best practices to optimize service delivery and resource allocation.

Documentation & Reporting: Develops monthly, quarterly, and annual reports summarizing program activities and outcomes.

• Maintain accurate records of authorizations, service utilization, and review outcomes in the electronic health record (EHR) system.
• Generate reports on utilization trends, service gaps, and compliance findings for leadership and regulatory bodies.
• Participate in internal and external audits and performance improvement initiatives.

Training & Support:

• Provide training to clinical and administrative staff on utilization management procedures and documentation best practices.
• Act as a resource for staff regarding funding policies, prior authorizations, and service eligibility requirements.

Claims & Reimbursement Processing:

• Manages data entry, editing, and submission of service activity reporting to funders, including Medicaid, Medicare, and other third-party payers.
• Ensures timely and accurate submission to funders in compliance with their respective guidelines and requirements.
• Supervises staff reimbursement to ensure all claims are submitted on time and are accurate.
• Monitors the claims and reimbursement processing for all payers.

System Management & Upgrades:

• Oversee the implementation of new software and system upgrades to enhance reimbursement processes.
• Coordinates with the IT department to troubleshoot any system issues related to billing and data submission.
• Maintains and updates the organization's Management Information Systems (MIS) and Reimbursement Manual to ensure compliance with HIPAA and funder guidelines.

Compliance & Quality Assurance:

• Ensures that all service data entered and reported meets funder requirements and adheres to federal, state, and Medicaid regulations.
• Conducts random audits of data submissions to confirm the accuracy of reporting and billing.
• Works closely with the Quality Department to monitor compliance with established quality and performance standards.

Staff Training & Development:

• Provide input and maintain communication with the various departments on changes affecting the data in the EMR system or the way in which such data is recorded by staff.
• Provide training to clinical and administrative staff on utilization management procedures and documentation best practices, proper billing, coding, and reimbursement procedures.
• Act as a resource for staff regarding funding policies, prior authorizations, and service eligibility requirements.
• Supports staff in understanding updates to third-party payer billing requirements and CPT code changes.
• Provides leadership and oversight for the reimbursement team, ensuring all department goals and deadlines are met.

Leadership & Administrative Duties:

Staff Supervision:

• Direct reimbursement staff on procedures for producing required data sets and claims for payment from various funders.
• Develops performance expectations for direct reports, provides performance reviews, and ensures the ongoing development of staff through mentoring, coaching, and training.
• Organizes work, delegates responsibilities, and ensures the efficient allocation of resources to meet departmental goals.

Candidate Requirements:

• Education: Bachelor's degree in business, Healthcare Administration, Social Work, Public Health, or related field. Master's degree preferred.
  • Minimum of seven years of billing/reimbursement experience, with at least four years in a supervisory role.
  • Previous experience in reimbursement, claims processing, or utilization management, preferably in community health.
  • Familiarity with Medicaid, Medicare, and other third-party reimbursement programs is preferred.
  • Thorough knowledge of the revenue cycle, benchmarks, technological systems and performance improvement strategies
  • Experience with change management and launching new programs and systems is a plus.
• Skills:
  • Strong understanding of Medicaid, community mental health policies, and behavioral health service delivery.
  • Excellent analytical, decision-making, and problem-solving skills.
  • Effective communication and collaboration skills to engage with multidisciplinary teams.
  • Proficiency in electronic health records (EHR) and data management systems.
  • Proficiency in Microsoft Office Suite and management information systems.
  • Knowledge of HIPAA regulations, coding, and reimbursement processes.
• Other:
  • Ability to work collaboratively with multiple departments and external stakeholders.
  • Strong problem-solving and decision-making capabilities.
  • Commitment to continuous improvement and keeping abreast of reimbursement and revenue cycle changes and best practices
  • Education to clinicians regarding billing practices and updates to coding

Neighborhood Service Organization is an equal opportunity employer and values diversity in its workforce. We encourage applications from all qualified individuals, including those with diverse backgrounds and those with disabilities.