Director, Revenue Cycle Management

At MEDvidi, we are transforming access to mental healthcare across the United States. Our telehealth platform connects patients with licensed medical providers in over 30 states, delivering high-quality care for ADHD, anxiety, depression, insomnia, and related conditions. **Role overiew** The Director of Revenue Cycle Management will design, build, and operationalize MEDvidi's end-to-end commercial insurance revenue cycle, beginning with Florida and California in 2026 and expanding to additional states thereafter. This role owns every stage of the revenue cycle from eligibility verification through payment posting, denial management, and payer performance reporting. This is a role for someone who has built the revenue cycle from the ground up in a behavioral health telehealth environment, and has the hands-on technical depth. **Revenue Cycle Infrastructure Build** - Design and implement end-to-end RCM workflows for a multi-state behavioral health telehealth practice, starting with commercial payer launch in Florida and California - Select, configure, and own the practice management and billing platform, including integration with the organization's EHR and CRM - Establish clearinghouse relationships, claims submission workflows, and electronic remittance and ERA posting processes - Develop and maintain the denial management taxonomy, root-cause analysis workflow, and resubmission processes by payer - Build cash flow forecasting models for the insurance ramp, including DSO assumptions by payer, denial rate benchmarks, and receivables aging **Credentialing and Payer Enrollment** - Own payer credentialing and enrollment for all providers across target commercial payers in each state, using a credentialing platform such as Medallion or equivalent - Establish and maintain CAQH profiles for all providers and ensure 90-day attestation cadence is met without lapse - Manage supervising physician co-credentialing in supervision states, coordinating with the CMO to ensure coverage is in place before claims are submitted - Track credentialing status, re-credentialing cycles, and payer contract effective dates in a system of record, distinguishing credentialing from contracting as separate workflows **Behavioral Health Coding and Billing Compliance** - Ensure accurate and defensible use of behavioral health CPT codes: psychiatric evaluation codes (90791, 90792), E/M codes for medication management (99213 through 99215), and add-on psychotherapy codes (90833, 90836, 90838) per AMA guidelines and payer-specific billing rules - Develop and enforce provider documentation standards supporting submitted codes, including DSM-criterion documentation, validated screening tools (PHQ-9, GAD-7), and telehealth-specific encounter requirements - Oversee certified coder pre-submission review of all claims, ensuring E/M level accuracy and appropriate ICD-10-CM diagnosis coding - Monitor OIG Work Plan priorities for behavioral health and telehealth and adjust internal audit protocols accordingly - Understand and apply MHPAEA (29 CFR Part 2590.712) requirements when appealing disproportionate payer denials or prior authorization practices **Payer Strategy and Contracting** - Conduct state-level payer analysis identifying the top commercial payers by covered lives and align target payer selection with the organization's insurance launch strategy - Lead payer contracting conversations in collaboration with the CMO and General Counsel, tracking negotiated rates, contract terms, and effective dates - Develop and maintain a payer performance dashboard tracking denial rates, DSO, reimbursement rates, and appeals outcomes by payer - Monitor telehealth billing rules by state and payer, including place-of-service code requirements (POS 02, POS 10) and originating site rules **Team Build and Provider Education** - Define staffing requirements for the RCM function and lead hiring of billing specialist, medical coder, and coding auditor as volume warrants - Establish…