Sr. director, rcm

About the Role

Daybreak Health delivers teletherapy to young people and families through schools, funded by health plans. As our Senior Director of Revenue Cycle Management, you will own the revenue cycle end to end, from enrollment through cash, for a payer mix that is narrow but operationally demanding: Medicaid and managed care organizations (MCOs), outpatient behavioral health, telehealth, and clinicians licensed across multiple states.

This is a build role, not a maintain role. You will inherit real gaps and be expected to close them with process and automation rather than headcount. You will report to our President and Co-Founder and lead the RCM team, which today includes an RCM Manager, a Lead Billing Specialist, and Billing Specialists. You will also partner closely with Finance, Clinical Operations, Product and Engineering, and Credentialing. You will present directly to executives and have clear line of sight into the cash you move.

We will not scale RCM by adding billing headcount in step with claim volume. We are looking for a leader who treats that as a design constraint and gets energized by it.

What You'll Own

• AR and denials. Read an aging report, know where the money is stuck, and fix the root cause, not just the claim. You will build the habit of tracing denials and slow-pay patterns back to the workflow, payer rule, or system gap that created them.
• Metrics and reporting. Run the function off numbers: net collection rate, days in AR, clean claim rate, denial rate, and cost to collect. Give leadership a view of collections they can trust, with definitions that hold up and reporting that does not depend on heroics.
• Systems. Own the EHR, clearinghouse, and billing platform relationships and configuration. Find process gaps and build solutions, including working with Engineering when the fix lives in the product.
• Front-end revenue integrity. Own real-time eligibility and benefits verification at intake, patient responsibility, and estimates. Most denials are created before the session happens. You will influence workflows you don't directly manage, particularly with Clinical Operations, and drive upstream behavior change.
• Automation and AI leverage. Default to eliminating repetitive work. You will identify where automation and AI can take over manual billing, posting, follow-up, and reconciliation work, and put them into production with the right controls.
• Cash forecasting. Be a credible partner to Finance at close, accruals, reserves, and AR allowance. Finance should never have to chase RCM for a number or wonder how it was built.
• Compliance. Adolescent behavioral health billing carries real confidentiality risk in EOBs, statements, and minor-consent handling, on top of HIPAA and payer audit exposure. You will build the operating discipline that keeps us compliant as we scale.

What Success Looks Like

• Leadership, Finance, and the executive team trust the NCR numbers, know what is driving them, and see them improve!
• AR is understood by payer, age bucket, and root cause, and aged balances are moving in the right direction.
• Denial and clean claim rates improve because upstream workflows (eligibility, authorization, intake, documentation) are fixed at the source.
• Manual billing work keeps getting simpler or automated, and RCM capacity scales more slowly than claim volume.
• Finance gets forecasts, accruals, and reserve inputs on time, with clear assumptions and honest variance explanations.
• Clinical Operations and RCM work from shared definitions and a shared view of how clinical workflows affect revenue.
• Confidentiality, minor-consent, and audit-readiness practices are documented, trained, and followed.

What We're Looking For

• 10+ years in RCM, including 5+ years leading RCM teams.
• Experience in one or two startups. You have built from square one and stayed flexible as the business changed.
• Deep outpatient behavioral health and Medicaid/MCO billing expertise.
• Practical, hands-on use of AI and automation to improve how work gets done, and good judgment about where human review still matters.
• A track record of standing up reporting, automating manual work, and leading system migrations.
• Comfort owning numbers publicly and being wrong out loud when the forecast misses.
• Strong executive communication. You can turn a complicated billing finding into a clear recommendation, with the 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 a multi-state licensed clinician workforce.
• Familiarity with BI tools.
• Exposure to value-based or outcomes-linked payer contracts.

Compensation and Benefits

The target base salary range for this role is $175,000, plus equity and benefits. Actual compensation will depend on experience, location, and internal equity considerations. Placement within the range reflects depth of behavioral health and Medicaid experience, startup build experience, and team size owned.

• Generous equity package
• Medical, dental, and vision coverage, with Daybreak covering a significant share of premiums for employees and dependents
• Flexible unlimited time off, company holidays, and quarterly mental health days
• Fully remote work from anywhere in the United States