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Salary: USD 175,000 - 0 / annual
Daybreak Health delivers teletherapy to young people and families through schools, funded by health plans. As Senior Director of Revenue Cycle Management, you will own the revenue cycle end-to-end, from enrollment through cash collection, for a payer mix focused on Medicaid and managed care organizations (MCOs) serving outpatient behavioral health and telehealth across multiple states.
This is a build role, not a maintain role. You will inherit real gaps and close them with process and automation rather than headcount. You will report to the President and Co-Founder and lead the RCM team, which currently includes an RCM Manager, a Lead Billing Specialist, and Billing Specialists. You will partner closely with Finance, Clinical Operations, Product, Engineering, and Credentialing, presenting directly to executives with clear visibility into cash movement.
Key responsibilities include:
**AR and Denials**: Read aging reports, identify where money is stuck, and fix root causes rather than individual claims. Trace denial and slow-pay patterns back to workflow, payer rule, or system gaps.
**Metrics and Reporting**: Run the function on data—net collection rate, days in AR, clean claim rate, denial rate, cost to collect. Provide leadership with trustworthy collections views backed by solid definitions and reliable reporting.
**Systems**: Own EHR, clearinghouse, and billing platform relationships and configuration. Identify process gaps and build solutions, working with Engineering when fixes live in the product.
**Front-End Revenue Integrity**: Own real-time eligibility and benefits verification at intake, patient responsibility, and estimates. Drive upstream behavior change with Clinical Operations and other teams you don't directly manage.
**Automation and AI Leverage**: Default to eliminating repetitive work. Identify where automation and AI can replace manual billing, posting, follow-up, and reconciliation, then deploy with appropriate controls.
**Cash Forecasting**: Be a credible partner to Finance on close, accruals, reserves, and AR allowance. Deliver numbers on time with clear assumptions.
**Compliance**: Adolescent behavioral health billing carries confidentiality risk in EOBs, statements, and minor-consent handling, plus HIPAA and payer audit exposure. Build operating discipline that scales compliance as the company grows.
Success means leadership trusts NCR numbers and sees them improve; AR is understood by payer and root cause with aged balances moving right; denial and clean claim rates improve through upstream workflow fixes; manual work gets simpler or automated while RCM capacity scales slower than claim volume; Finance receives timely forecasts with clear assumptions; Clinical Operations and RCM share definitions and understanding of how clinical workflows affect revenue; and confidentiality, minor-consent, and audit-readiness practices are documented, trained, and followed.
The company will not scale RCM by adding billing headcount in step with claim volume. You should treat this as a design constraint and get energized by it.
**Requirements:**
- 10+ years in RCM, including 5+ years leading RCM teams
- Experience in one or two startups; ability to build from square one and stay flexible as business changes
- Deep outpatient behavioral health and Medicaid/MCO billing expertise
- Practical, hands-on use of AI and automation to improve work, with good judgment about where human review still matters
- Track record of standing up reporting, automating manual work, and leading system migrations
- Comfort owning numbers publicly and being wrong out loud when forecasts miss
- Strong executive communication; ability to turn complicated billing findings into clear recommendations with tradeoffs spelled out
- Ability to influence stakeholders and drive change without direct authority, especially across Clinical Operations, Product, and Engineering
**Nice to Have:**
- Experience with school-based, pediatric, or youth behavioral health programs
- Experience billing across multiple states with multi-state licensed clinician workforce
- Familiarity with BI tools
- Exposure to value-based or outcomes-linked payer contracts
