The Silent Backbone of Behavioral Health: Meet the (Often Overlooked) Revenue Cycle Team
If you are on a ship or an airplane, do you see the engine?
When people think about healthcare, they think about physicians, nurses, and frontline clinical staff. But there is a vital component: the revenue cycle operations team, who are largely unsung. I call them the “silent backbone” of behavioral health. I feel I should say they are not silent with me. I have known these folks forever. They are like family.
I often wonder how CEOs can function without knowing and understanding the revenue cycle; it’s so important. I’m losing some of my skills because everyone on this team is surpassing me. Without this team, the organization would sink. I actually wrote an article comparing taking on Sanford Behavioral Health with my son’s LEGO Titanic project, which is another story. However, in righting the Sanford ship, this team is invaluable to me.
Oddly, even though revenue cycle is a central component of any system, no one seems to know the behind-the-scenes of what these guys do. It’s misunderstood as just billing. However, the revenue cycle team is crucial to client care because without getting paid, we can’t support clients or bring in more individuals who need help. So, let’s start at the front door, introduce the most overlooked team at Sanford, and bring them into the light.
The Silent Backbone of Mental Health
It is overwhelming for families and clients who are already facing a crisis to have to think about money. I’ll give an example. My husband had surgery recently, and his insurance is through his work. He was about to head into the operating room when they said, “You owe us $7,000. Unfortunately, we are not going to be able to do the surgery unless you pay.” Now I know my benefits. I know it was outpatient, and I know my out-of-pocket because I have a tracker. They just looked at our card. They didn’t even verify our benefits. I, of course, did the verification of benefits with them, and it was resolved, but what if you don’t know how to do that?
Which is why our team is so effective. They are highly competent and empathetic: there is a deep human element to all of them. And although their work goes unrecognized and they don’t talk about it much, it is impactful to every aspect of Sanford Behavioral Health. Let’s start with Janestha Draper.
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Janestha outside of work and her family.
Janestha Draper, Benefits Verification
I’m pretty shy; I work remotely from New Hampshire and handle benefits verification. I’ve been with Sanford about three years now. I’m somebody who looks at life as a glass half-full all the time. It is rare for me not to enjoy the tedium of things. In my job, there is a lot of waiting on the phone. I think it is vital that we communicate clearly and appropriately with clients and families. As a mother of three, I understand how frightening and overwhelming this process can be. I juggle between working full-time and parenting full-time. My youngest one is 3, so I have to keep my eyes and ears open beyond what’s happening on the computer to make sure he’s not getting into things he shouldn’t be (often he is). That’s just life. Another thing about me is that my father-in-law owned a treatment facility. That’s how I met Tracy Rogers.
Off duty, hanging out with dear friend Tash and babysitting a friend’s pet rat.
Marina Hanna, Billing and Reconciliation
I’m probably the newest person on the revenue cycle team. I have learned a lot from everyone here. After college, I worked at a psychiatric facility as a direct care worker. Shortly after COVID hit, I met Vanessa and Tracy. They gave me the opportunity of a lifetime, moving from that front-facing role. I loved working with patients, but it was so hard physically, mentally, and emotionally. I want to be in a space where I can do something impactful and also learn skills helpful in my life, like billing.Â
I do the billing and reconciliation, correcting claims when they come back and reconciling between different systems at Sanford. I think my favorite aspect is the reconciliation process; I’ve learned I have a deep need to analyze stuff. The cool thing about insurance is that there are guidelines! At the same time, there is a learning curve because these insurance companies don’t have standard coding every single time, and I have to figure out what they might want. As Tracy said, no one wants to be at the pinnacle of a health crisis and then get an unexpected bill in the mail. Surprises are not conducive to bettering your mental health. So I like to get things done right. Interestingly, I did not know anything about insurance when I took the job (to my detriment personally). I am now comfortable approaching the intricacies of these insurance companies, and I can take the pressure off our clients. Â
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Mary Roberts and husband off the grid!
Mary Roberts, Insurance Collections
I’ve been at Sanford for about three years, and I really enjoy what I do. I work directly with payors, and if there’s money out there, that’s due, I’m completely dedicated to getting exactly what’s due. If a claim has been delayed or denied, I will work until the end and the reimbursement comes through. If we take care of everything on the front end, like getting authorizations, it makes my job much easier. Payment should process as long as the policy is active and prior approved. And that’s the fun part. If you come into a place that’s having challenges, it’s nice to see the results when you can bring the cash back. But I enjoy everyone that I work with. It’s a great team. Everybody helps each other, so that’s really nice.Â
Vanessa Rados
Vanessa Rados, Problem Solver
I’m so excited for this article! I honestly have a hard time describing my role at Sanford because it’s all over the place. I’m the go-to problem solver, and my tasks change daily based on the immediate needs. I work on the consulting side and have experience in all things RCM and data analytics. I provide versatile end-to-end support across the entire financial ecosystem. Shifting between technical and operational tasks allows me to support billing, cash posting, claims follow-up, A/R management, data analytics, finance, systems support, and software integrations. I don’t have a daily routine here, and my role is defined by adaptability. I step in wherever support is needed most at any given moment!
Chris Kitterman and his wife on the town.
Chris Kitterman, Resource
 I have been in revenue cycle now for about six years. And I joined Tracy’s team here at Sanford in late September of 2023. The RCM team at Sanford really is the trifecta: Janestha, Marina, and Mary. I was originally at Sanford full-time; now I pop in and out as a resource. For the most part, like Mary, I deal with collections.Â
Claims can start to build up unpaid, unpaid, unpaid. Before you know it, your cash flow is dying. And if you don’t have the proper people in place, like Mary, to identify it on the backside, or Marina to make sure that it goes out on the front side, you don’t collect. Then you devote resources that continue to grow more and more, chasing all that back-end stuff. With a perfect claim, you touch it once and cash the check. But if it’s an imperfect claim, you touch it repeatedly, and you can’t solve that problem. And it can become quite frustrating. However, if you find the problem, you can usually fix it pretty quickly.
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They are not silent with me.
I call this group the “silent backbone” because we support staffing and payroll behind the scenes. Also, it is rare for the ground teams to interact with them, other than Marina occasionally. I don’t think Sanford staff understand what Janestha does. But for me, when she went on vacation and I had to fill in, she is indispensable! I was exhausted! Sanford folks and our patients rarely see what’s happening out of public view, yet the work keeps getting done. The revenue cycle team is not bedside with clients, and that is a good thing. It means the revenue cycle is working and cash is coming in.
All my bright ideas that I’ve pushed to the leadership team would not be possible without revenue cycle. Expansion would not be possible. There is no sustainability without their expertise, so it’s appropriate that this team has a sense of pride. To go back to the Titanic analogy, the revenue cycle team is an unseen engine. If you are on a ship or an airplane, do you see the engine?Â
For My Article “Righting the Ship – Reflections on My First Year as CEO of Sanford Behavioral Health,” Click the LINK.
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