Job Description:
• Lead all Medicaid billing processes (network and out-of-network) across our multi-state operations.
• Manage and optimize performance of our third-party billing vendor handling out-of-network claims.
• Track and improve key revenue cycle metrics including days in A/R, denial rates, collection ratios, and first-pass claim acceptance.
• Collaborate with clinical, medical, and administrative teams to ensure accurate documentation, timely charge entry, and proper coding.
• Leverage our EMR and RCM platforms (experience with Kipu and/or Collaborate MD strongly preferred).
• Manage claim submissions, follow-up, appeals, payer relations, and reimbursement optimization with a primary focus on Medicaid.
• Develop billing workflows, policies, and internal controls to support scalability as the organization grows.
• Provide leadership, training, and mentorship to internal billing staff while maintaining strong coordination with external partners.
• Monitor regulatory changes, payer policies, and industry updates affecting behavioral health billing.
• Deliver regular performance reports and revenue forecasts to senior leadership.
Requirements:
• 3–7+ years of progressive medical billing experience with a strong emphasis on Medicaid billing (network and out-of-network) in healthcare, ideally in behavioral health or substance abuse treatment.
• Prior experience managing billing teams or third-party billing vendors is highly preferred.
• Hands-on experience with AI-driven billing tools, automation, or financial reporting integrations (especially for revenue cycle analytics and operational reporting) will be a strong differentiator.
• Hands-on proficiency with Kipu EMR and/or Collaborate MD RCM systems is a significant advantage.
• Deep knowledge of revenue cycle management, claim editing, denial management, appeals, and compliance requirements.
• Strong analytical skills with the ability to identify trends, solve problems, and drive process improvements.
• Excellent communication and collaboration skills.
• Must be based in or willing to work from one of our primary locations: Houston, TX, Atlanta, GA, or Wilmington, NC.
• We are open to candidates across different experience levels — from seasoned directors ready to fully own and scale the function to strong Medicaid billing professionals who can effectively manage the third-party partner while growing into the broader director role.
Benefits:
• We also provide a basic benefits package.