Director, Revenue Cycle Management (RCM) - Chiropractic Health Partners (CHP)

About CHP:

Chiropractic Health Partners (CHP) is a Management Services Organization (MSO) that acquires and grows practices by providing its partner physicians with the resources, analytics, and expertise needed to add new service lines, build de novo locations, recruit additional providers, improve marketing and optimize processes. We enable our chiropractic doctors and providers to focus on patient care while we focus on managing the business aspects of their practice. The organization continues to grow rapidly through its acquisition strategies and growth initiatives.

The Brydon Group (www.brydon.com), invested in CHP in July 2023, recognizing the need for larger players in this highly fragmented market.

About the role:

The Director of Revenue Cycle Management (RCM) will be a key member of the executive management team for this fast-paced, innovative growth company comprised of multiple chiropractic practice brands. The Director of RCM will be held accountable for:

• Leading, improving, centralizing and scaling the billing department at CHP
• Ensuring compliance with payer relationships and reporting standards, and ensure that CHP’s billing practices align with regulatory guidelines, GAAP standards and healthcare compliance rules
• Resolve complex billing issues, optimize and improve billing processes to maximize reimbursements, reduce/eliminate rejections and denials of insurance claims, and file claims in an accurate and timely fashion

This highly analytical detail-oriented collaborative executive will manage all aspects of CHP’s billing department. The leader will work with other MSO executives to identify areas of opportunity and growth and to educate providers on current coding and documentation regulations.

Responsibilities:

Supervise the billing team, manage daily assignments, work hours, vacation time, and ensure timely and accurate completion of tasks. Train and develop staff. Periodically audit staff work to ensure compliance and efficiency

Insurance Claims Management: Lead end-to-end billing processes for CHP including reviewing and posting charges, reviewing medical documentation, and writing and reviewing coding claim edits

Personal Injury Claims Management: Lead end-to-end billing and settlement processes for CHP collaborating with respective practice administrators and business development managers to ensure there is a balance between strengthening attorney relationships and maximizing settlements. Manage medical records and other document requests from attorneys.

Verification of Benefits: Oversight of verification of patients’ insurance benefits and patient communication about their coverage and financial responsibilities

Claims Submission: Accurately prepare, submit, and follow up on claims to insurance companies in a timely manner, ensuring compliance with payer policies. Manage clearinghouse account and ensure smooth operation of electronic claims submission

Denial Management: Review, appeal and resolve denied and underpaid claims to maximize reimbursement for services rendered

Patient Billing: Prepare and send patient statements, answer billing inquiries, and manage payment collections, including setting up payment plans when necessary. Maximize upfront patient collections and process patient refunds

Reimbursement tracking: Track all claims and payments to ensure proper and timely reimbursement, minimizing outstanding balances. Manage AR reports

Credentialing: Coordinate credentialing of all providers and entities with payers with our credentialing partner

Communicate with the billing team and key stakeholders on changes in reimbursement and expectations of changes in insurance guidelines

Collaborate with senior leadership on development of strong departmental objectives and key results. Develop a RCM dashboard with objective KPI metrics to track the performance of the billing department and billing team employees

Deliver actionable insights and recommendations based on billing performance data

Identify opportunities for automation to improve billing efficiency and opportunities to offshore some billing team tasks to reduce departmental costs. Work with IT to implement software improvements and resolve technical issues

Demonstrate knowledge of CHP’s mission, vision, and values; provides leadership, and adheres to applicable standards, policies and procedures, operating instructions, regulatory compliance requirements, confidentiality standards and the code of ethical behavior

Characteristics and Behaviors for Success:

• A strong reputation for building, developing and leading a respected and growth-oriented billing department with a strong desire to win in a highly competitive marketplace.
• A results-oriented style that focuses collaboration with matrix teams to achieve results.
• Ability to master complex business problems and have the intellect and pragmatism to be able to effectively handle ambiguity and manage change. Ability to adapt and be flexible in a rapid changing work environment is required
• Foster a success-oriented, accountable environment within the organization
• Highly skilled in diplomacy, influencing, and collaborating in decision-making processes across all levels of the organization

Qualifications:

• Bachelor’s degree in Healthcare Administration, Business Administration or a related field required; Master’s degree a plus
• Minimum of 10+ years of experience in medical billing and revenue cycle
• At least 5 years’ direct managerial experience
• Experience working in a healthcare services MSO is required
• 3+ years of experience in personal injury claims and MVA
• AAPC billing/coding certification required
• Comprehensive knowledge of billing, HCPCS, CPT and ICD codes, insurance verification, authorization processes and payer guidelines
• A wide range of experience across multiple specialties and ancillary services, multi-state billing, Medicare and other government programs, tele-health billing, workers’ compensation and value-based care
• Must be willing to occasionally travel to CHP’s affiliated practice locations in the Mid-Atlantic and Southeastern US

Salary will be commensurate with experience and include a performance bonus component. CHP offers employees health, dental and vision insurance, 401k w/ 4% match, STD, LTD and life insurance.