Job Summary
Director of Billing Services
Legacy Recovery Center
Department: Revenue Cycle / Billing
Reports To: Chief Executive Officer / Executive Leadership
Employment Type: Full-Time, Exempt
Position Summary
Legacy Recovery Center is seeking an experienced Director of Billing Services to lead and oversee all aspects of the organization’s revenue cycle and commercial insurance billing operations.
Legacy Recovery Center provides residential behavioral health treatment and works exclusively with commercial insurance payers. The Director of Billing Services will be responsible for ensuring timely, accurate, and compliant billing; maximizing collections; minimizing denials and aging accounts receivable; and maintaining effective systems for utilization-related billing requirements, claims submission, payment posting, appeals, and payer follow-up.
This position serves as the organizational leader for billing and revenue cycle performance and works closely with executive leadership, admissions, utilization review, clinical services, medical staff, and finance to ensure that services provided are properly authorized, documented, billed, and collected.
The ideal candidate has significant experience with behavioral health and residential treatment billing, including commercial insurance, in-network and out-of-network reimbursement, single case agreements, medical necessity requirements, denial management, and payer negotiations.
Essential Duties and ResponsibilitiesRevenue Cycle Management
- Oversee the complete revenue cycle from admission through final payment and account resolution.
- Develop, implement, and maintain billing processes designed to maximize reimbursement and reduce delays in payment.
- Ensure clean and timely submission of claims to commercial insurance carriers.
- Monitor accounts receivable and establish processes for aggressively addressing aging claims.
- Maintain oversight of outstanding balances, unpaid claims, underpayments, denials, and payer discrepancies.
- Identify revenue leakage and implement corrective measures.
- Establish and monitor billing department productivity and collection standards.
- Provide executive leadership with regular reporting regarding revenue cycle performance.
Commercial Insurance Billing
- Maintain expert knowledge of commercial behavioral health insurance billing practices.
- Oversee billing for residential behavioral health services and other services provided by Legacy Recovery Center.
- Ensure claims are submitted according to individual payer requirements, contracts, authorizations, and reimbursement methodologies.
- Maintain working knowledge of in-network, out-of-network, and Single Case Agreement reimbursement.
- Review payer contracts and fee schedules to ensure payments are consistent with contracted reimbursement rates.
- Identify and pursue insurance underpayments.
- Coordinate with payers regarding claim discrepancies, reimbursement issues, and recurring billing problems.
- Maintain familiarity with major commercial insurance carriers and behavioral health benefit administrators.
Insurance Verification & Financial Clearance Oversight
- Collaborate with admissions and verification-of-benefits staff to ensure insurance benefits are accurately verified prior to admission.
- Ensure deductible, coinsurance, copayment, out-of-pocket maximum, authorization, network status, and behavioral health benefits are properly identified.
- Establish processes for identifying potential reimbursement issues prior to admission.
- Assist leadership in evaluating financially complex admissions when necessary.
- Ensure relevant insurance and financial information is accurately communicated between admissions, billing, utilization review, and leadership.
Authorization & Utilization Review Coordination
- Work closely with the Utilization Review department to ensure authorization information supports accurate billing.
- Monitor authorized dates and levels of care to prevent billing for unauthorized services.
- Identify authorization gaps that could create reimbursement risk.
- Collaborate with clinical and UR leadership when additional documentation is required by a payer.
- Ensure billing practices correspond with authorized level of care and dates of service.
Claims Management
- Ensure claims are submitted accurately and within payer timely filing requirements.
- Monitor clearinghouse rejections and payer claim rejections.
- Ensure rejected claims are corrected and resubmitted promptly.
- Monitor claim status and establish appropriate payer follow-up intervals.
- Ensure claims are appropriately coded and supported by documentation.
- Maintain effective processes for corrected claims and reconsiderations.
Denial Management & Appeals
- Develop and oversee a comprehensive denial-management program.
- Review denial trends and identify root causes.
- Categorize denials according to authorization, medical necessity, coding, eligibility, timely filing, documentation, contractual, and other issues.
- Oversee preparation and submission of payer reconsiderations and appeals.
- Coordinate with clinical and utilization review staff when clinical documentation is required for appeals.
- Escalate high-dollar or systemic payer issues when appropriate.
- Maintain tracking of appeals, overturn rates, and recovered revenue.
- Implement corrective action when recurring denial patterns are identified.
Accounts Receivable
- Maintain active oversight of the organization's insurance accounts receivable.
- Establish aging benchmarks for 30-, 60-, 90-, and 120+-day accounts.
- Identify high-dollar outstanding claims requiring immediate intervention.
- Establish collection priorities based upon balance, age, payer, and likelihood of recovery.
- Ensure insurance companies are contacted consistently regarding outstanding claims.
- Develop strategies to reduce Days in Accounts Receivable.
- Recommend write-offs only after reasonable collection and appeal efforts have been exhausted and according to organizational policy.
Payment Posting & Reconciliation
- Ensure insurance payments, adjustments, denials, and patient responsibility amounts are posted accurately.
- Review Explanation of Benefits and Electronic Remittance Advice information for payment discrepancies.
- Identify underpayments and improper payer adjustments.
- Coordinate with finance/accounting to reconcile deposits and payments.
- Ensure contractual adjustments are consistent with payer agreements.
- Maintain appropriate controls to ensure all revenue received is accurately accounted for.
Payer Relations
- Develop and maintain professional working relationships with commercial insurance companies and behavioral health payer representatives.
- Escalate recurring reimbursement and claims issues to payer representatives.
- Participate in payer meetings and negotiations when appropriate.
- Identify patterns of improper denials or reimbursement and present supporting data to leadership and payers.
- Assist executive leadership with evaluation of payer contracts and reimbursement performance.
- Provide data regarding payer performance to support future contracting decisions.
Billing Compliance
- Ensure all billing activities comply with applicable federal and state regulations and payer requirements.
- Maintain compliance with HIPAA and patient confidentiality requirements.
- Ensure claims accurately reflect services provided and documented.
- Monitor billing practices for potential compliance concerns.
- Maintain appropriate documentation supporting claims, adjustments, appeals, refunds, and write-offs.
- Assist with payer audits and internal compliance reviews.
- Coordinate with compliance and executive leadership regarding identified billing risks.
Department Leadership
- Recruit, train, supervise, and evaluate billing and revenue cycle personnel as applicable.
- Establish clear performance expectations for billing staff.
- Develop written policies, procedures, and workflows for the billing department.
- Conduct routine billing and accounts receivable meetings.
- Provide ongoing education regarding payer requirements and changes in reimbursement practices.
- Ensure adequate staffing and workload distribution.
- Hold team members accountable for established productivity and collection standards.
- Foster a culture of urgency, accuracy, accountability, professionalism, and ethical billing practices.
Key Performance Indicators
The Director of Billing Services will be responsible for monitoring and improving key revenue cycle metrics, including:
- Total Accounts Receivable
- Days in Accounts Receivable
- Accounts Receivable over 90 days
- Accounts Receivable over 120 days
- Clean Claim Rate
- Initial Claim Acceptance Rate
- Denial Rate
- Appeal Success Rate
- Collection Rate
- Net Collection Rate
- Gross Collection Rate
- Average reimbursement per patient/day
- Average reimbursement by payer
- Underpayment recovery
- Authorization-related denials
- Medical necessity denials
- Timely filing denials
- Average time from date of service to claim submission
- Average time from claim submission to payment
- Outstanding high-dollar claims
- Monthly cash collections
The Director is expected to provide executive leadership with regular reports explaining performance, significant outstanding claims, payer trends, risks, and opportunities for revenue improvement.
Interdepartmental Collaboration
The Director of Billing Services will work closely with:
- Executive Leadership
- Admissions
- Verification of Benefits
- Utilization Review
- Clinical Services
- Medical Providers
- Nursing
- Finance/Accounting
- Compliance
- Business Development when appropriate
The Director is responsible for ensuring that billing-related information moves efficiently between departments and that operational issues affecting reimbursement are identified and corrected.
QualificationsRequired
- Minimum of 5 years of healthcare revenue cycle or medical billing experience.
- Minimum of 3 years of management or leadership experience within billing, collections, or revenue cycle management.
- Demonstrated experience billing commercial insurance.
- Strong understanding of insurance claims, reimbursement, denials, appeals, and accounts receivable.
- Experience interpreting Explanation of Benefits (EOBs), Electronic Remittance Advice (ERAs), payer contracts, and fee schedules.
- Strong understanding of authorization and medical necessity requirements.
- Demonstrated ability to manage high-dollar accounts receivable.
- Strong analytical and problem-solving skills.
- Excellent organizational and communication abilities.
- High attention to detail and ability to manage multiple revenue cycle priorities simultaneously.
- Ability to maintain confidentiality and comply with HIPAA requirements.
Strongly Preferred
- Experience in behavioral health, mental health, substance use disorder treatment, or residential treatment billing.
- Experience billing residential behavioral health levels of care.
- Experience with in-network and out-of-network commercial insurance reimbursement.
- Experience with Single Case Agreements.
- Experience managing behavioral health insurance appeals.
- Knowledge of behavioral health utilization management and authorization processes.
- Experience working with major national commercial insurance carriers.
- Experience overseeing a billing department or third-party billing vendor.
- Experience analyzing payer reimbursement performance.
- Experience assisting with payer contracting and reimbursement negotiations.
Knowledge, Skills & Abilities
The successful candidate should possess:
- Expert-level understanding of commercial insurance revenue cycle management.
- Strong knowledge of behavioral health reimbursement practices.
- Ability to analyze large accounts receivable reports and identify collection priorities.
- Ability to identify systematic causes of denials and revenue loss.
- Strong negotiation and payer-escalation skills.
- Ability to communicate complicated reimbursement issues clearly to executive leadership.
- Strong leadership and staff-development capabilities.
- Ability to create and enforce effective billing workflows.
- Strong financial and analytical aptitude.
- High level of personal accountability and ownership over revenue cycle performance.
- Ability to work effectively in a fast-paced and growing behavioral healthcare organization.
Performance Expectations
The Director of Billing Services is expected to take direct ownership of the financial performance of the revenue cycle. Success in this position will be measured not simply by claims being submitted, but by the organization's ability to convert properly delivered and authorized patient care into collected revenue.
The Director is expected to proactively identify problems rather than waiting for claims to become significantly aged. Significant denials, authorization gaps, reimbursement issues, payer trends, or collection risks should be communicated to executive leadership promptly along with a recommended course of action.
About Legacy Recovery Center
Legacy Recovery Center provides residential behavioral health treatment with a focus on delivering high-quality, individualized care to individuals requiring intensive mental health and co-occurring behavioral health services.
Legacy Recovery Center works with commercial insurance payers and is committed to maintaining ethical, accurate, and compliant reimbursement practices while ensuring that the organization receives appropriate payment for medically necessary services provided to its patients.
Equal Employment Opportunity
Legacy Recovery Center is an Equal Opportunity Employer and is committed to maintaining a professional workplace free from unlawful discrimination and harassment. Employment decisions are based on qualifications, performance, organizational needs, and other legitimate business considerations.
Pay: $75,000.00 - $90,000.00 per year
Benefits:
- Dental insurance
- Health insurance
- Paid time off
Work Location: Remote
