Director of Revenue Cycle Management na Agape Network

Position: Director of Revenue Cycle Management 

Reports To: Chief Administrative Officer

Position Summary: The Director of Revenue Cycle Management is a high-impact leadership role responsible for the strategic direction, oversight, and operational management of the entire revenue cycle within Agape Network. This role will develop and lead a high-performing RCM team responsible for optimizing the organization’s revenue cycle operational performance. These functions include but are not limited to direct billing operations, claims submission, payment posting, denial management, accounts receivables, provider credentialing, and support payer contracting activities—while developing strategies, workflows, and policies that ensure accurate and efficient reimbursement of services rendered.

Essential Duties and Responsibilities:

1. Optimize end-to-end RCM operations for efficient and profitable outcomes.  

2. Support executive leadership in strategic planning, budgeting, and reporting on billing operations. 

3. Training and development of team members will be a key focus, ensuring maximum efficacy and efficiency of RCM operations.

4. Monitor KPIs such as A/R days, denial rates, and collection efficiency to inform performance improvement initiatives.

5. Analyze trends in reimbursement outcomes and recommend strategies for improved revenue collection. 

6. Establish and maintain relationships with payers, vendors, and provider representatives.

7. Oversee Agape Network’s provider credentialing and recredentialing policies, procedures and compliance with state, federal and health plan requirements.    

8. Drive adoption of best practices in EHR systems and revenue cycle technology. 

9. Lead and manage RCM teams responsible for A/R resolution, claims processing, payment posting and provider credentialing. Providing guidance and direction over revenue cycle operations and supporting the professional development of the RCM team.

10. Maintaining knowledge of billing regulations, payer requirement changes and emerging billing technologies.

11. The role also involves reviewing existing policies and procedures, providing recommendations for improvement, and facilitating communication and coordination with cross-departmental teams, and third parties to ensure effective information exchange.

12. Provide technical guidance and assist with projects assigned.

13. Collaborates with clinical, administrative, and financial teams to ensure accurate and timely billing, as well as providing guidance of revenue cycle principles practices, procedures, contractual compliance, and internal controls.

14. Manage Provider Credentialing & Recredentialing Processes.

15. Oversee end-to-end credentialing and recredentialing of all licensed providers, ensuring compliance with organizational policies and payer requirements.

16. Monitor and maintain up-to-date credentialing files and expiration tracking for all providers.

17. Develop and enforce credentialing policies and procedures in accordance with standards with NCQA, CMS, and state-specific regulations.

18. Supervise Credentialing Staff and Credentialing Workflow

19. Serve as the primary liaison between credentialing, medical staff, providers, and payers to resolve issues and ensure smooth onboarding.

Qualifications: Minimum of 6 years of RCM experience in a management role. Minimum of 3 years in a Behavioral Health provider setting. Certified in Billing, coding, and RCM (required). Advanced knowledge of medical billing guidelines, A/R processes, CPT/ICD-10/HCPCS coding, and Florida Medicaid Behavioral Health Managed Care Plans. Proven experience in developing policies, managing high-volume claims, and driving cash collection success. Proficient in with Excel (VLOOKUP, pivot tables, etc.)

Reasonable accommodation will be provided to enable employees with disabilities to perform the essential functions.

Education and/or Experience: Bachelor’s degree or master’s degree in healthcare administration or finance (required). 

Reasoning Ability: Ability to apply common sense understanding and carry out instructions furnished in written or oral form.

Physical demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation will be provided to enable employees with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands and be able to talk, hear and see. The employee will have to sit and stand for indefinite periods of time. Specific visual abilities required by this job include close vision, distance vision and peripheral vision. The employee may occasionally be required to lift and/or move up to fifteen pounds.

Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation will be made to enable employees with disabilities to perform the essential functions. Most of the work is in a climate-controlled facility. The noise level varies from quiet to moderate too loud.