Mount Rogers Community Services Board
Director of Reimbursement
Mount Rogers Community Services Board, Wytheville, Virginia, United States, 24382
Job Description
OPEN UNTIL FILLED
JOB SUMMARY
:
The Director of Reimbursement is responsible for planning, organizing, and managing the operation of the Agency's billing department. Supervises the preparation of claims and ensures revenue maximization from Medicaid, Medicare, other third party payers, and individual client payments. Resolves critical and complex billing issues. Assesses the efficiency of billing services and develops and implements needed process improvements and operational changes. Manages quality assurance initiatives for billing purposes. Works closely with data administration and management. Supervises reimbursement staff. Provides training.
ESSENTIAL FUNCTIONS
:
Responsible for the management and oversight of the Agency's computerized billing of third parties which include, but are not limited to Medicaid, Medicare, commercial insurances, and individuals served. This includes performing monthly quality assurance procedures on reports prior to billing to alert staff of payer issues which need additional attention before bill is submitted; analyze collection data to identify issues which need additional follow-up, and ensure data is adequate for billing.
Monitor governmental and commercial insurance reimbursement regulation changes to ensure the Agency's compliance with payer regulations to enable the Agency to prepare for reimbursement and to optimize payments as appropriate. Identify and resolve issues that impact revenue generation. Review, make recommendations, and implement revenue methods which would enhance the Agency's revenue. (make recommendations on a different billing codes).
Review and maintain all contracts with third party billers. Responsible for negotiation with third party billers to obtain best revenue maximization for Agency.
Communicate with office and direct care staff regarding existing and changing regulations, research topics and trouble shooting of issues. Serve as a resource for direct care staff. Provide training and guidance to staff in resolving difficult account issues and to help prevent denials and non-payment. Write, review, and maintain business documents including reports, contracts, manuals, and procedures.
Responsible for credentialing of Agency's licensed staff (doctors, nurses, FNP, LPC, LCSW) including requesting confidential information and/or materials from staff, making application and serving as liaison with insurer. Perform re-credentialing as required. Maintain records of staff licenses and related documentation.
Analyze reports, monitor and analyze revenue trends, examine and identify patterns of rejections or denials from third party payers, identify problems, make and implement solutions for reimbursement issues and revenue enhancement methods. Communicate with quality control staff and program directors regarding billing status, issues or changes. Develop reports for senior management to address questions or needs.
Support Agency management in long-range planning efforts regarding reimbursement issues in response to Agency growth.
Supervise staff in the billing department to ensure billing is generated in a timely manner; assure setup and deactivation of service codes, event rules, bill specs, authorized service and re-code tables and other necessary items to ensure billing compliance; assure follow-up on denials and/or rejections with funding sources are reviewed and resubmitted (if required).
OTHER DUTIES
:
Perform such other duties as assigned by supervisor.
QUALIFICATIONS
:
Strong attention to detail
Good written and oral communication skills
Research and analysis skills
Report preparation and documentation skills
Ability to train other team members.
Job Requirements
EXPERIENCE/EDUCATION REQUIRED
:
Bachelor’s degree in Accounting, Business, Management or a related field.
Five years’ experience in management of reimbursement activities.
Two years’ experience in a progressive supervisory role managing a team of several members.
Knowledge of and prior experience with Medicare, Medicaid, and commercial insurance billing and collections.
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OPEN UNTIL FILLED
JOB SUMMARY
:
The Director of Reimbursement is responsible for planning, organizing, and managing the operation of the Agency's billing department. Supervises the preparation of claims and ensures revenue maximization from Medicaid, Medicare, other third party payers, and individual client payments. Resolves critical and complex billing issues. Assesses the efficiency of billing services and develops and implements needed process improvements and operational changes. Manages quality assurance initiatives for billing purposes. Works closely with data administration and management. Supervises reimbursement staff. Provides training.
ESSENTIAL FUNCTIONS
:
Responsible for the management and oversight of the Agency's computerized billing of third parties which include, but are not limited to Medicaid, Medicare, commercial insurances, and individuals served. This includes performing monthly quality assurance procedures on reports prior to billing to alert staff of payer issues which need additional attention before bill is submitted; analyze collection data to identify issues which need additional follow-up, and ensure data is adequate for billing.
Monitor governmental and commercial insurance reimbursement regulation changes to ensure the Agency's compliance with payer regulations to enable the Agency to prepare for reimbursement and to optimize payments as appropriate. Identify and resolve issues that impact revenue generation. Review, make recommendations, and implement revenue methods which would enhance the Agency's revenue. (make recommendations on a different billing codes).
Review and maintain all contracts with third party billers. Responsible for negotiation with third party billers to obtain best revenue maximization for Agency.
Communicate with office and direct care staff regarding existing and changing regulations, research topics and trouble shooting of issues. Serve as a resource for direct care staff. Provide training and guidance to staff in resolving difficult account issues and to help prevent denials and non-payment. Write, review, and maintain business documents including reports, contracts, manuals, and procedures.
Responsible for credentialing of Agency's licensed staff (doctors, nurses, FNP, LPC, LCSW) including requesting confidential information and/or materials from staff, making application and serving as liaison with insurer. Perform re-credentialing as required. Maintain records of staff licenses and related documentation.
Analyze reports, monitor and analyze revenue trends, examine and identify patterns of rejections or denials from third party payers, identify problems, make and implement solutions for reimbursement issues and revenue enhancement methods. Communicate with quality control staff and program directors regarding billing status, issues or changes. Develop reports for senior management to address questions or needs.
Support Agency management in long-range planning efforts regarding reimbursement issues in response to Agency growth.
Supervise staff in the billing department to ensure billing is generated in a timely manner; assure setup and deactivation of service codes, event rules, bill specs, authorized service and re-code tables and other necessary items to ensure billing compliance; assure follow-up on denials and/or rejections with funding sources are reviewed and resubmitted (if required).
OTHER DUTIES
:
Perform such other duties as assigned by supervisor.
QUALIFICATIONS
:
Strong attention to detail
Good written and oral communication skills
Research and analysis skills
Report preparation and documentation skills
Ability to train other team members.
Job Requirements
EXPERIENCE/EDUCATION REQUIRED
:
Bachelor’s degree in Accounting, Business, Management or a related field.
Five years’ experience in management of reimbursement activities.
Two years’ experience in a progressive supervisory role managing a team of several members.
Knowledge of and prior experience with Medicare, Medicaid, and commercial insurance billing and collections.
#J-18808-Ljbffr