Director of Revenue Cycle in Las Vegas, Nevada at Nevada Behavioral Health / NovumHealth

The Director of Revenue Cycle provides leadership and oversight of the organization's Billing and Credentialing Departments. This position is responsible for ensuring accurate and timely billing, efficient provider credentialing and enrollment, compliance with payer requirements, and continuous process improvement.

The Director oversees departmental performance, establishes operational standards, and collaborates with leadership and clinical teams to support organizational goals.

Essential Duties and Responsibilities

* Oversee daily operations of the Billing and Credentialing Departments, including supervision of the Billing Manager and credentialing staff.

* Establish departmental goals, productivity standards, and performance expectations.

* Develop and implement policies, procedures, and workflows to improve efficiency and accuracy.

* Manage staffing, training, employee development, and departmental accountability.

Billing Oversight

* Ensure accurate and timely claims submission to Medicaid, commercial insurance, and other contracted payers.

* Monitor billing accuracy, productivity, claim rejections, and denial trends.

* Ensure compliance with coding standards, payer contracts, authorization requirements, and billing regulations.

* Support the Billing Manager in resolving complex billing issues and improving departmental processes.

* Collaborate with clinical operations to address documentation and billing-related concerns.

Credentialing Oversight

* Oversee provider credentialing, recredentialing, and payer enrollment activities.

* Ensure timely and accurate completion of applications, renewals, and enrollment requirements.

* Monitor credentialing timelines, provider participation status, and departmental productivity.

* Maintain compliance with payer requirements and applicable regulations.

* Coordinate with HR, recruiting, contracting, and clinical operations to support timely provider onboarding.

Payer Coordination and Compliance

* Maintain effective relationships with contracted payers and assist with escalated billing and credentialing issues.

* Ensure departmental compliance with federal and state regulations, HIPAA, and payer requirements.

* Participate in audits and implement corrective actions as needed.

* Support new payer contracts, provider expansion, and changes in payer requirements.

* Performance and Process Improvement

* Develop and monitor key performance indicators for billing and credentialing.

* Identify opportunities for workflow improvements, automation, and operational efficiencies.

* Provide regular departmental performance updates to executive leadership.

* Ensure departmental processes align with organizational objectives.

Qualifications

* Bachelor's degree in Healthcare Administration, Business Administration, Finance, or related field preferred; equivalent experience considered.

* Minimum 3-5 years of experience in healthcare billing, credentialing, or revenue cycle operations.

* Minimum 3 years of supervisory or management experience.

* Behavioral health experience strongly preferred.

* Experience with Medicaid managed care and commercial insurance payers preferred.

* Knowledge of healthcare billing, coding, provider credentialing, payer enrollment, and regulatory compliance.

* Experience with electronic health records and practice management systems, including AdvancedMD, preferred.

* Strong leadership, communication, organizational, and problem-solving skills.

* Ability to manage multiple priorities and collaborate across departments.

Key Performance Indicators

* Claim submission timeliness and accuracy

* Clean claim rates and billing error reduction

* Credentialing and payer enrollment turnaround times

* Timely recredentialing and renewals

* Departmental productivity and performance

* Compliance with payer and regulatory requirements

* Process improvements and operational efficiency

Additional Responsibilities

* Perform other duties as assigned by executive leadership.