Volunteers of America Chesapeake & Carolinas is a regional nonprofit serving communities across Maryland, Virginia, the District of Columbia, and the Carolinas. Its programs support vulnerable individuals and families through housing and homeless services, healthcare, mental health care, substance use recovery, intellectual and developmental disability services, veteran assistance, community re-entry, and workforce development. The organization works with local programs and community partners to connect people with practical resources, supportive services, and pathways toward greater self-sufficiency and stability.
Director of Federal MCO Revenue Cycle Management (Maryland Remote)
Leads Medicaid and commercial insurance revenue cycle operations for behavioral health programs, including billing, denials, audits, authorizations, and EHR compliance. Oversees billing, authorization, and credentialing teams while coordinating accurate and timely reimbursement.
Description
- Lead the full revenue cycle, covering eligibility, authorizations, contracting, credentialing, claims, collections, denials, reporting, and reconciliations
- Report to the Vice President of Finance
- Supervise medical billing, authorization, and credentialing personnel
- Maintain EHR configuration and workflows in accordance with payer requirements
- Verify insurance coverage and keep consumer records accurate in the EHR
- Process 270/271 eligibility files at the start of each month
- Keep authorizations current and request supplemental units when necessary
- Clear pre-billing reports ahead of weekly billing and month-end or year-end close
- Oversee Medicaid billing extraction, posting, review, and transmission
- Reconcile billing reports against delivered services and submitted claims
- Resolve rejected 837P files and submit corrected claims
- Post payments and address denials within the month they are received
- Approve write-offs and adjustments and complete EHR hard closes
- Deliver monthly reports on revenue recognition, accounts receivable reconciliations, adjustments, and payments by the 10th
- Support annual financial audits and payer claims audits
- Apply internal and payer requirements in partnership with the Compliance team
- Confirm that providers satisfy licensure and credentialing requirements for billing
- Track accounts receivable, appeals, and claim corrections within federal and MCO deadlines
- Work with staff to resolve billing issues and denied claims, arranging meetings when needed
- Maintain relationships with community resources and partner agencies
- Stay current on billing practices and state and local billing procedures
- Follow VOACC and program policies and procedures
- Maintain required service records with the Finance team
- Participate in staff and organizational meetings and complete other assigned duties
- Travel to designated locations and use office equipment as required
Requirements
- Bachelor’s degree in healthcare administration or a related discipline
- At least five years of experience with Medicaid payments, private insurance, or revenue cycle operations
- At least three years of experience supervising staff and managing goals and development
- Specialized training in Medicaid or healthcare billing and revenue cycle procedures
- Ability to establish claim-accuracy controls, correct recurring errors, and develop solutions for timely processing
- Experience coordinating workflows, supervising and training staff, and managing changes to payment processes and procedures
- Experience handling appeals and reconciling billing and coding errors for reimbursement
- Experience leading teams and managing goals, benchmarks, and KPI matrices
- Ability to research, prepare, maintain, and accurately review reports and documentation on schedule
- Strong problem-solving and execution abilities
- Cultural responsiveness and comfort working with people from diverse backgrounds
- Excellent written and verbal communication skills
- Proficiency with Microsoft Word, PowerPoint, Excel, and Outlook
- Experience with Credible Software, practice management systems, and third-party clearinghouses
- Ability to learn and use varied technology systems and general office resources
- Ability to drive and travel to assigned locations
- Master’s degree preferred
- CPC, CPB, or CCS certification preferred
- Bilingual ability in any language is a plus
Benefits
- Additional benefits are provided.