• Job Description

  Req#: 26-00097
  
  Director of Behavioral Health Claims
  
  About SimiTree
  SimiTree provides client-centric services to Behavioral Health organizations across Mental Health, Substance Use Disorder, Eating Disorder, Applied Behavioral Analysis, and Psychiatric specialties. Our organization comprises clinical, operational, and revenue-cycle experts who support our clients. SimiTree has developed a full suite of custom-designed services focusing on areas critical to quality improvement, operational efficiency, accurate reimbursement, and regulatory compliance.
  To give our clients the opportunity to focus on core operations, SimiTree offers full Revenue Cycle outsourcing or a combination of its components. SimiTree’s client base ranges from small, community-based agencies to publicly traded national chains. We have both the technical expertise and real-world experience to deliver seamless solutions that help agencies navigate a rapidly changing operational and regulatory environment.
  
  Job Overview:
  The Director of Behavioral Health Claims will lead the planning, implementation, and oversight of RCM claim management, manage team performance and budgets, and foster a culture of innovation and operational excellence within the organization. The Director of Behavioral Health Claims will be responsible for analyzing client projects to develop the optimal billing, collection, posting, and management methodologies to drive cash and provide forecasted collected revenues, and work with other departments and analytics to provide timely reporting to senior management and clients. The Director of Behavioral Health Claims monitors and reports monthly on KPIs relevant to each client’s account and internal operational KPIs, staff productivity, and quality controls . This role will ensure a robust and effective QC and accountability program that drives operational excellence and high-performing RCM on accounts. This role is critical for overseeing revenue cycle functions, ensuring billing, collections, denial management, and cash postings are executed accurately, on time, and in full compliance with healthcare regulations. The ideal candidate will bring measurable success in optimizing revenue workflows, analyzing key performance indicators (KPIs), reducing denials, accelerating cash flow, implementing and managing successful quality control and accountability programs, and leading high-performing teams to achieve consistently superior outcomes.
  
  Responsibilities:
  • Leading team performance and managing budgets to enhance service lines
  • Manage forecasts, budgets, and quality performance outcomes.
  • Oversee standard operating procedures (SOPs) and operations reporting
  • Maintain expertise in service lines to address and resolve specific customer issues.
  • Remove obstacles that hinder productivity and help the team stay focused
  • Analyze revenue cycle metrics to identify trends, issues, and opportunities for improvement.
  • Evaluate current AR processes, workflows, and staffing structure; implement improvements to centralize and optimize operations
  • Drive enterprise-level reporting on open AR, unapplied cash, variances, SLAs, and KPI metrics across all revenue segments
  • Manage claims submissions, follow up on unpaid claims, and work with insurance companies to resolve issues.
  • Provide training and support to staff on revenue cycle best practices and compliance requirements.
  • Implementing improvements to processes that support posting services to enhance performance and scalability
  • Driving execution to achieve results and maximize opportunities for improvement in revenue management
  • Fostering a culture of innovation and commitment within the organization.
  • Build trust through consistent accountability and communication with both internal and external stakeholders
  • Works with internal departments or clients to minimize errors that disrupt the revenue cycle continuum.
  • Promotes a service-oriented culture and assures client satisfaction with the quality of the payment services and feedback provided.
  • Conduct staff meetings at regular intervals for informative and educational purposes.
  • Conduct periodic performance appraisals in accordance with Simitree policy and practices.
  • Follows Best Practice requirements for payment posting and is responsible for the education of staff regarding these requirements.
  • Completes weekly/monthly reporting to management, as required.
  • Makes determination of staffing needs. Participates in hiring, disciplinary, and termination decisions
  • Set and monitor annual performance goals and conduct performance reviews.
  • Identify training needs for your team and provide development opportunities.
  • Recommend or initiate personnel actions as needed.
  • Responsible for employing operational policies and procedures within the department
  
  
  Education and Experience
  • Bachelor’s degree in business, Healthcare Administration, or related field
  • 7-9 years combined of billing, AR, and/or payment posting experience, with at least 6 years in a supervisory or managerial role.
  • An equivalent combination of education, training, and relevant experience will be considered
  • Demonstrates understanding of accounting principles and receivables management in a healthcare-related field required
  Qualifications:
  Required:
  • Strong knowledge of CMD, Therapy Notes, Advanced MD, and My Evolv billing systems
  • Strong knowledge of SharePoint, Direct Claims and Salesforce platforms
  • Strong knowledge of Medicare, Medicaid, and Commercial payer rules.
  • Experience with high-volume, multi-state behavioral health or medical billing.
  • Ability to interpret EOBs, remittances, payer policies, and denials.
  • Proficiency in Microsoft Office and billing systems.
  • Strong communication and problem-solving skills.
  • Reconcile clients' cash logs daily, weekly, and monthly
  • Ability to identify, research, and troubleshoot payment posting errors in a timely manner
  • Strong organizational skills with the ability to manage daily posting volumes while meeting deadlines and productivity expectations
  • Ability to analyze payment data and identify trends for process improvement
  • Ability to document posting activity clearly and consistently within billing systems, including notes, denials, and recoupments
  • Effective written and verbal communication skills to collaborate with executive/senior leadership, ASRs, managers, internal departments, clients, and downstream teams such as the billing, collections, and payment posting team
  • Basic mathematical aptitude for validating units, charges, rates, and billing calculations
  • Ability to work independently while also functioning effectively as part of a billing, collections, and posting team
  • Advanced knowledge of standard office software, including word processing, spreadsheets, databases, and internet-based applications
  Physical Requirements:
  • Activities require a significant amount of sitting at an office workstation in front of a computer monitor.
  • Ability to travel as needed for the position via airline or vehicle transportation.
  • Regularly required to verbally communicate, listen, and give presentations as needed.
  
  The physical requirements are representative of those an employee must meet to successfully perform the essential functions of the job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
  
  Salary range/ Benefits :
  $135,000- $150,000 annually
  
  The compensation scale listed is a general salary range and is not intended to represent the actual annual or hourly compensation rate for this role. An offer will be made to the selected candidate at the conclusion of the interview process based on their relevant experience and the responsibilities of the position. SimiTree offers a competitive compensation package including health, vision, and dental insurance, PTO, retirement plans (401K), holiday paid time off, life insurance, sick time, and opportunities for professional development.
  
  
  #INT1
  
  
  
  

• About the company

  SimiTree Healthcare Consulting unites former Simione and BlackTree experts, services, and approaches to help post-acute organizations raise performance levels and realize revenue potential in a complex market. SimiTree's services include Consulting, Mergers & Acquistions, Talent Solutions, Data Analytics, and Outsourced Services for home health, hospice, and palliative industries.

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