Gut Feelings Psychosomatic Medicine
Psychiatry Revenue Cycle Manager
Gut Feelings Psychosomatic Medicine, Oakland, California, United States, 94616
Gut Feelings Psychosomatic Medicine is an interventional psychiatry practice delivering TMS, IV ketamine,
Spravato
(and other buy‑and‑bill injectables), and stellate ganglion blocks alongside telepsychiatry. We’re largely out‑of‑network and navigate in‑network exceptions along with mental health carveouts. We’ve decided to
insource
revenue cycle to raise the bar on coding accuracy, prior authorizations, denial overturns, and financial reporting.
The Role You will
own the revenue cycle end‑to‑end —from eligibility and prior auths through clean claims, payment posting, denials, appeals, underpayment recovery, and actionable reporting. You’ll
lead a small offshore team
(benefits/auths, claims, posting, denials) and set the standard for quality, speed, and compliance.
What You’ll Do
Serve as the practice’s
RCM authority
for interventional psychiatry, in‑network & out‑of‑network mechanics, and payer‑specific rules.
Lead
troubleshooting
workflows like pre‑payment review: build document checklists, draft cover letters, coordinate medical‑necessity narratives, track releases, and elevate when needed.
Manage
single case agreements/network exceptions
and support
peer‑to‑peer scheduling
for complex authorizations.
Patient Access & Prior Authorizations
Oversee eligibility/benefits verification (carve‑outs, COB, payer ID accuracy).
Decide
pharmacy vs medical benefit
for Spravato and govern
buy‑and‑bill
decisions with risk controls.
Charge Capture, Coding, and Edits
Implement payer‑specific coding rules, modifiers, and documentation standards for interventional psychiatry.
Maintain pre‑submission edits and rejection sweeps (999/277CA) to sustain high clean‑claim rates.
Run routine
coding QA
and feed findings back to clinicians.
Claims, Payments, and Reconciliation
Oversee 837 submissions, clearinghouse rejections, and payer portal follow‑up.
Supervise
ERA/835 auto‑posting
and manual EOB workflows; reconcile to bank daily.
Maintain
GL‑ready exports
that clearly separate
drug/COGS (J‑codes/NDC)
from professional services.
Denials, Appeals, and Underpayments
Own the
denials taxonomy ; drive root‑cause remediation.
Draft high‑quality
appeals
with supporting documentation (PPR, medical necessity, benefits, policy citations).
Run
underpayment audits
against expected allowances; dispute variances.
Oversee generation, accuracy, and timely delivery of
patient statements
(e.g., copays, OON balance bills, Good Faith Estimates).
Respond to patient billing questions and resolve discrepancies with empathy and professionalism.
Set and enforce policies for
payment plans, refunds, and financial hardship adjustments .
Ensure all patient payments are posted correctly and reconciled to the patient ledger.
Provide clear explanations of insurance EOBs, balances, and write‑offs to patients as needed.
Coordinate with clinical and front‑desk staff to prevent avoidable patient balance issues.
Leadership & Teaming
Manage 1–3 offshore VAs (eligibility/benefits, auths, claims/AR, posting/denials) with clear SOPs and QA.
Train staff; run weekly denials scrums; publish dashboards; continuously improve processes.
Systems
Tools you’ll touch:
AdvancedMD
(PM/EHR),
Change Healthcare
(primary clearinghouse),
Availity
(backup), payer portals, e‑fax, inventory (e.g., FlexScanMD), QBO, ClickUp (tasking).
Enforce HIPAA safeguards, role‑based access, and secure credential management.
Success Looks Like (your KPIs)
Denial rate ≤ 5–7%
with demonstrable root‑cause fixes
Posting within 48 hours
of ERA;
$ underpayments recovered
monthly
PPR : count submitted, % released,
average days‑to‑release , dollars released
What You Bring
5+ years
RCM leadership
with behavioral health or
procedure‑heavy
specialty; interventional psych strongly preferred.
Hands‑on success with
out‑of‑network
billing,
prior auths ,
network exceptions/SCAs , and
prepayment reviews
(Anthem a plus).
Strong command of clearinghouses (Change/Waystar), payer portals, 835/837/277CA, denial codes (CARC/RARC), and appeal construction.
Comfort leading
offshore teams
with SOPs, QA, and measurable SLAs.
Advanced
Excel/Sheets ; report building; GL mapping experience (QBO).
Exceptional written communication and documentation discipline.
Nice to Have
Prior experience stabilizing a practice during
PPR
or payer audits.
Exposure to TMS and SGB coding/documentation nuances.
Experience with multi‑site or multi‑state growth.
Competitive salary + performance bonus tied to KPIs (open to part‑time for exceptional candidates). Medical/dental/vision, PTO, CME/education stipend, 401k. Final package DOE. #J-18808-Ljbffr
Spravato
(and other buy‑and‑bill injectables), and stellate ganglion blocks alongside telepsychiatry. We’re largely out‑of‑network and navigate in‑network exceptions along with mental health carveouts. We’ve decided to
insource
revenue cycle to raise the bar on coding accuracy, prior authorizations, denial overturns, and financial reporting.
The Role You will
own the revenue cycle end‑to‑end —from eligibility and prior auths through clean claims, payment posting, denials, appeals, underpayment recovery, and actionable reporting. You’ll
lead a small offshore team
(benefits/auths, claims, posting, denials) and set the standard for quality, speed, and compliance.
What You’ll Do
Serve as the practice’s
RCM authority
for interventional psychiatry, in‑network & out‑of‑network mechanics, and payer‑specific rules.
Lead
troubleshooting
workflows like pre‑payment review: build document checklists, draft cover letters, coordinate medical‑necessity narratives, track releases, and elevate when needed.
Manage
single case agreements/network exceptions
and support
peer‑to‑peer scheduling
for complex authorizations.
Patient Access & Prior Authorizations
Oversee eligibility/benefits verification (carve‑outs, COB, payer ID accuracy).
Decide
pharmacy vs medical benefit
for Spravato and govern
buy‑and‑bill
decisions with risk controls.
Charge Capture, Coding, and Edits
Implement payer‑specific coding rules, modifiers, and documentation standards for interventional psychiatry.
Maintain pre‑submission edits and rejection sweeps (999/277CA) to sustain high clean‑claim rates.
Run routine
coding QA
and feed findings back to clinicians.
Claims, Payments, and Reconciliation
Oversee 837 submissions, clearinghouse rejections, and payer portal follow‑up.
Supervise
ERA/835 auto‑posting
and manual EOB workflows; reconcile to bank daily.
Maintain
GL‑ready exports
that clearly separate
drug/COGS (J‑codes/NDC)
from professional services.
Denials, Appeals, and Underpayments
Own the
denials taxonomy ; drive root‑cause remediation.
Draft high‑quality
appeals
with supporting documentation (PPR, medical necessity, benefits, policy citations).
Run
underpayment audits
against expected allowances; dispute variances.
Oversee generation, accuracy, and timely delivery of
patient statements
(e.g., copays, OON balance bills, Good Faith Estimates).
Respond to patient billing questions and resolve discrepancies with empathy and professionalism.
Set and enforce policies for
payment plans, refunds, and financial hardship adjustments .
Ensure all patient payments are posted correctly and reconciled to the patient ledger.
Provide clear explanations of insurance EOBs, balances, and write‑offs to patients as needed.
Coordinate with clinical and front‑desk staff to prevent avoidable patient balance issues.
Leadership & Teaming
Manage 1–3 offshore VAs (eligibility/benefits, auths, claims/AR, posting/denials) with clear SOPs and QA.
Train staff; run weekly denials scrums; publish dashboards; continuously improve processes.
Systems
Tools you’ll touch:
AdvancedMD
(PM/EHR),
Change Healthcare
(primary clearinghouse),
Availity
(backup), payer portals, e‑fax, inventory (e.g., FlexScanMD), QBO, ClickUp (tasking).
Enforce HIPAA safeguards, role‑based access, and secure credential management.
Success Looks Like (your KPIs)
Denial rate ≤ 5–7%
with demonstrable root‑cause fixes
Posting within 48 hours
of ERA;
$ underpayments recovered
monthly
PPR : count submitted, % released,
average days‑to‑release , dollars released
What You Bring
5+ years
RCM leadership
with behavioral health or
procedure‑heavy
specialty; interventional psych strongly preferred.
Hands‑on success with
out‑of‑network
billing,
prior auths ,
network exceptions/SCAs , and
prepayment reviews
(Anthem a plus).
Strong command of clearinghouses (Change/Waystar), payer portals, 835/837/277CA, denial codes (CARC/RARC), and appeal construction.
Comfort leading
offshore teams
with SOPs, QA, and measurable SLAs.
Advanced
Excel/Sheets ; report building; GL mapping experience (QBO).
Exceptional written communication and documentation discipline.
Nice to Have
Prior experience stabilizing a practice during
PPR
or payer audits.
Exposure to TMS and SGB coding/documentation nuances.
Experience with multi‑site or multi‑state growth.
Competitive salary + performance bonus tied to KPIs (open to part‑time for exceptional candidates). Medical/dental/vision, PTO, CME/education stipend, 401k. Final package DOE. #J-18808-Ljbffr