JOB PURPOSE: The Director of Reimbursement must position to maximize third party and incentive revenue. This includes analyzing, modeling, and forecasting Health Care Reimbursement systems and negotiations of contracts.
MAJOR RESPONSIBILITIES (Essential functions):
Result #1: The Billing Manager achieves fulfillment of Billing Department objectives by effectively managing staff and available talent management tools.
Assisting/support the Billing Manager in interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems
RESULTS #2: All systems are in place for third party and incentive revenue:
Credentialing-meet and review clinicians’ insurance status with the credentialing specialist.
Meaningful Use- Enter data in MEIPASS system to receive MU incentive revenue
PCMH-Keep the PCMH clinician reports up to date and send to NCQA as needed
MCVR-Run and analyze Medicaid Managed care payments yearly and report to NYS
EMR-manages information systems that support the finance functions
Statements-Run and review patient statements monthly, continually review patient self-pay accounts and create efficient processes to collect.
Quality Improvement team-Work with QI team to ensure we are submitting the quality of care information to payers to receive incentive revenue.
Medicaid Redesign-Attend meetings as needed and understand the future of Medicaid reimbursement.
RESULTS #3: Program outcomes of the 330 Grant are strengthened by:
Setting up the sliding scale yearly
Monitor and Interpret the PIN
Maintain and create policies and protocols for the sliding scale grant
Results #4: All related revenue opportunities are captured and reimbursement risk is abated by:
Administrating and coordinating revenue integrity audits of services provided to or by the Billing Department
Identifying lost revenue opportunities operationally
Working with the practice managers to maximize reimbursement from the front end to the back and ensure an appropriate process.
Results #5: Jordan Health is in full compliance with all financial reporting requirements related to billing and reimbursements by:
Credit balances-review credit balances for patients and insurance companies and ensuring they are returned timely
Coding-review coding issues with Billing Manager and Coder
Fraud and Abuse –comply with Fraud and Abuse regulations set by OMIG and OIG
Working with auditors as needed, assisting in the coordination of timely responses to governmental and third-party audits as well as with appeals to government agencies
Billing and Reimbursement Policies-update as needed
Ascertaining that billing & reimbursement policies and procedures are being followed by all departments of the center
Results #6: New insurance companies are on boarded and rates are negotiated to cover the centers cost:
Overseeing the administration of all financial matters pertaining to third party revenue and other alternative reimbursement methods.
Assisting Jordan Health in financial negotiations with other organizations
Results #7: Jordan Health has an effective financial management system related to Third party Revenue and reimbursements by:
Projecting Third party revenue
Ensuring that the financial and contractual adjustments are appropriate
Reviewing Aging reports
Hard close the month
Creating and Reviewing Monthly Finance Dashboards as needed
Annually reviewing and adjusting charges as needed
Running and Analyzing reports for accuracy and making decisions based on data
EDUCATION AND EXPERIENCE REQUIRED:
Four year degree in Business Management or equivalent outside experience, at least 7 years of medical billing and collection experience, four years of managerial experience in the health care field. Certified Professional Coder or Certified Medical Biller preferred. Excellent analytical and problem solving skills necessary. Ability to communicate well with others.
LICENSES AND CERTIFICATIONS:
Preferred Certified Professional Coder by AAPC, CPC, CCSP or AHIMA credentials required; strong emphasis on ambulatory coding.
SPECIAL SKILLS, KNOWLEDGE REQUIRED:
Must be proficient in:
o MS Office Applications (Word, Access, Excel, Power Point, Outlook)
o eClinicalWorks or other electronic health record