Breakthrough Behaviorial Resources

Director of Billing

Employment Classification

• This position may be filled as a W-2 employee or as a 1099 independent contractor, depending on business need, scope of engagement, and degree of direction and control involved.
• If engaged as a 1099 independent contractor, the individual must establish and maintain a formal business entity (DBA or LLC) with its own business EIN, and must submit all required credentialing documentation, prior to contract execution and service delivery.
• Employment classification is determined by Breakthrough Behavioral in accordance with IRS common-law and Texas Workforce Commission standards, and is subject to periodic review.
• Director-level titles carrying supervisory authority over staff and operational decision-making are more consistent with W-2 classification; confirm with counsel before offering this role on a 1099 basis.

Roles and Responsibilities

• Oversee and manage all aspects of Breakthrough Behavioral's billing operations, including Medicaid, MCO, and third-party payer claims submission and reconciliation.
• Develop and maintain billing policies and procedures in compliance with Texas Medicaid, MCO contracts, and applicable state and federal regulations.
• Monitor claims for timely, accurate submission; oversee denial management, appeals, and resubmission processes.
• Partner with the Clinical Compliance Director and QM/UM staff to ensure clinical documentation supports billed services, consistent with documentation standards under 26 TAC Chapter 301, Subchapter G.
• Supervise and develop billing department staff; establish productivity and quality standards for the team.
• Analyze billing data and reimbursement trends; report key metrics (accounts receivable days, denial rates, collection rates) to executive leadership.
• Ensure compliance with payer contracts, provider credentialing/enrollment requirements, and applicable coding standards (CPT/HCPCS, ICD-10).
• Maintain up-to-date knowledge of Medicaid and MCO billing rule changes and communicate impacts to affected departments.
• Serve as the primary point of contact for payer audits and billing-related regulatory inquiries.
• Collaborate with HR/Operations to ensure credentialing documentation needed to support claims is current and complete for both employees and contractors.

Compliance Requirements

• Must maintain current working knowledge of Texas Medicaid, MCO, and applicable payer billing requirements.
• Responsible for ensuring billing practices align with 26 TAC Chapter 301, Subchapter G and applicable federal Medicaid billing regulations.
• Must pass a criminal background check per agency policy.
• Must safeguard protected health information (PHI) in accordance with HIPAA and agency privacy policy.

Minimum Qualifications

• Bachelor's degree in healthcare administration, business, accounting, finance, or a related field (Master's degree preferred).
• Progressive experience in healthcare or behavioral health billing/revenue cycle management, including Medicaid and MCO billing; HR/leadership to confirm minimum years threshold.
• Prior supervisory or leadership experience within a billing or revenue cycle function.
• Certified Professional Coder (CPC) or comparable billing/coding certification preferred.

Knowledge, Skills, and Abilities (KSAs)

• Deep knowledge of revenue cycle management and Medicaid/MCO billing regulations.
• Denial management and payer appeals expertise.
• Staff leadership, coaching, and performance management skills.
• Strong data analysis and reporting skills tied to billing/financial KPIs.
• Proficiency with EHR/billing platforms (Notenetic or comparable systems).
• Attention to detail and ability to research and interpret evolving payer regulations.
• Clear communication with payers, regulators, and internal leadership.