Revenue Cycle Manager

The Revenue Cycle Manager is responsible for overseeing all aspects of the SUD and Mental Health revenue cycle process for multiple affiliated companies, from patient intake and insurance verification through claims submission, collections, reporting, compliance, and audit readiness. This position ensures efficient revenue capture, timely reimbursement, regulatory compliance, and accurate financial projections and reporting while collaborating with clinical, admissions, billing, and leadership teams.

Oversee and support revenue cycle activities related to patient registration, intake, and insurance verification, including:

• Patient chart creation, demographic collection, and pre-assessment processes
• Insurance verification and eligibility determination
• Authorization management and insurance benefit verification
• Monitoring accuracy and timeliness of patient registration and admission workflows
• Insurance credentialing and rate negotiations

Ensure revenue integrity through ongoing review and monitoring of clinical and billing activities, including:

• Documentation review in partnership with clinical and medical teams
• Charge capture oversight
• Accurate coding and billing practices for Medicaid and Insurances
• Identification and resolution of documentation deficiencies that may impact reimbursement

Manage all reimbursement and accounts receivable functions, including:

• Claims submission through the EMRs and clearinghouse platforms
• Insurance payment reconciliation and receipt tracking
• Denial management and appeals
• Patient billing processes
• Monitoring billing accuracy against provider credentials, licensure, signatures, and supporting documentation
• Peer to Peer reviews with Payers
• Payment Postings
• Preparation and coordination of payer audits, recoupments, and reimbursement reviews

Develop and maintain revenue cycle reporting and performance metrics, including:

• Weekly and monthly revenue cycle reports
• Expected Payment reports
• Monitor and analyze key performance indicators
• Reconciling billing system data with accounting records
• Providing financial projections and revenue forecasts
• Presenting revenue cycle performance data and recommendations to leadership

Ensure organizational compliance with payer, regulatory, and accreditation requirements, including:

• Maintaining Medicaid and Managed Care Organization (MCO) enrollments
• Managing CAQH profile updates
• Monitoring provider credentialing and recredentialing deadlines
• Ensuring compliance with Medicaid regulations, payer contracts, and ASAM criteria
• Developing, maintaining, and updating revenue cycle policies and procedures
• Supporting internal and external audits and corrective action plans

• Bachelor’s degree in healthcare administration, Business Administration, Finance, Accounting, or related field preferred
• Minimum of 3-5 years of progressive revenue cycle management experience in healthcare special focus on verification of benefits on many insurance policies (i.e., in-network, out of network plan benefits and deductibles)
• Experience with behavioral health, substance use treatment, or related healthcare settings preferred
• Experience managing insurance billing, claims processing, denials, collections, and reimbursement processes
• Comprehensive knowledge of healthcare revenue cycle operations
• Understanding of Medicaid, managed care, commercial insurance, and payer requirements
• Knowledge of healthcare compliance regulations and audit processes
• Experience with EMR and billing systems
• Strong analytical and financial reporting skills (highly experienced in Microsoft Excel use and PowerPoint presentations)
• Excellent attention to detail and organizational abilities
• Ability to interpret reimbursement data and identify revenue optimization opportunities
• Strong communication and collaboration skills
• Ability to manage multiple priorities and meet deadlines in a fast-paced environment
• Proven ability to effectively lead, manage, and develop a high-performing team
• Ability to establish clear expectations, assign responsibilities, monitor performance, and hold team members accountable for results
• Strong people-management skills, including the ability to motivate, engage, and retain employees in a fast-paced healthcare environment
• This position may require the use of a Company or personal vehicle. Candidates must have a valid driver’s license.

Full Circle Recovery Services is a Drug-Free Workplace:
The Medical Marijuana Registration Card is not accepted for any employee.