Manager, Revenue Cycle

About us:

Forge Health is a mission-driven outpatient mental health and substance use provider dedicated to providing the highest quality, affordable, and effective “one-stop-shop” care to individuals, families, and communities in need. As the first and only behavioral healthcare provider with a proven, national payer-validated ability to drive clinical outcomes that span all areas of health, Forge Health is leading the charge in driving innovation, improving care delivery, and shaping the future of behavioral health care.

At Forge, clinical care is paramount – it’s the heartbeat of our operations and the driving force in everything we do. The skill and compassion of our staff are the crucial components to extraordinary experiences and outcomes for those we serve. With our current clinical footprint in the greater Northeast, we have offices in New York, New Jersey, Pennsylvania, New Hampshire, Massachusetts – and we’re growing! For the third consecutive year, were thrilled to share that Forge Health has been recognized on the prestigious Inc. 5000 list of the fastest-growing private companies in America– a remarkable honor that is a testament to our team's relentless commitment to our mission.

If you are passionate about providing high quality, evidence-based care for individuals in need through an innovative practice, then Forge is the right fit for you!

What We’re Looking For

Reporting to the Vice President of Revenue Cycle, the Manager (Director) of Revenue Cycle Management will lead the day-to-day operations associated with patient eligibility, charge entry, accounts receivable management and patient invoice management. This role will be responsible for driving achievement of effective billing performance, through management of workload inventories, quality of billing submissions to insurance companies/ patients and active management of payments that may be delayed due to denial of charges at the insurance company or other related impacts to accurate revenue collection.   The manager works collaboratively with internal partners to ensure timely and accurate billing and works actively with insurance company partners to resolve outstanding billing issues.   The revenue cycle leader will manage a team of ~11 and will continually monitor and influence the execution of the team through use of performance data, quality monitoring and general business data.

As an experienced, collaborative, and hands-on key member of the team, you will serve as a strong, trusted business partner and revenue cycle expert working directly with clinical and business leaders around the company.  You will leverage department data to help provide performance insights to Forge Health leaders.   This input will help inform business decisions, relationship management with key stakeholders as well as investments in process and tool improvements.

This position is a remote opportunity. 

What you'll be doing:

• Actively manage billing work inventories relates to mental health and substance use disorder services with commercial health plans, state Medicaid and managed-care organizations, and Medicare.
• Proactively identify situations which require intervention (i.e. denials, underpayments, and other issues). Plan, prepare, and conduct corrective course of action(s) in partnership with key stakeholders.
• Make corrections to staff execution and/ or business process challenges that lead to revenue collection delays
• Ensuring that patient insurance eligibility is actively managed to ensure smooth billing experience for patients and effective submission to the applicable insurance companies.
• Effectively utilize available data to identify key performance theme and trends.
• Active coaching and development of teammates as it relates to their direct performance of defined objectives as well as their professional development
• Fostering a team environment that promotes performance, belonging and engagement.
• Ensure that the Revenue Cycle team executes the defined processes in accordance with applicable regulations, policies and procedures.
• Partner with leadership to develop, recommend, and implement payor contracting strategy for fee-for-service and value-based initiatives with commercial health plans, Medicaid, and Medicare partners – actively providing data to senior leadership for negotiations with existing and new payor partners.
• Identify and ensure revenue cycle management training needs at all levels of the organization, and foster change to achieve performance improvement initiatives.
• Prepare impactful reports, analytics, summaries, and visualizations to communicate findings.

What You’ll Need

• Bachelor’s degree in healthcare administration, business, finance, or a related field (Master's degree preferred).
• At least seven (7) years of experience in revenue cycle management in healthcare in positions of increasing responsibility
• Experience working with commercial health insurance companies, Medicaid programs, and Medicare programs.
• Experience in revenue cycle management in behavioral health preferred.
• Strong analytical and problem-solving skills, with the ability to interpret complex financial data and trends to develop effective revenue cycle strategies.
• Demonstrate comprehension of payor contracts, with special attention to complexities and details.
• Excellent leadership abilities, with a track record of building and motivating high-performing revenue cycle teams within addiction treatment facilities.
• Solid understanding of healthcare regulations, including HIPAA and confidentiality requirements specific to substance abuse treatment.
• Proficiency in revenue cycle management software and systems, with the ability to leverage technology for process automation and efficiency.
• Professional certifications in revenue cycle management or addiction treatment billing are highly preferred.