Director of Federal & MCO Revenue Cycle Management (70130)

JOB SUMMARY:

The Sr. Director of Federal & MCO Revenue Cycle Management reports to the Vice President of Finance and is responsible for managing the entire revenue cycle, including but not limited to, eligibility, authorizations, contracting and credentialing, claims billing, collections, rejections and denials management, monthly and yearly fiscal reporting and reconciliations, and assisting with compliance reporting and audits. In addition, the Director is responsible for informing and training appropriate staff on any new billing procedures and will attend outside trainings and meetings. They will work closely with the Regional Vice Presidents and Finance to ensure programs comply with payer regulations and maximize revenue cycle performance.

RESPONSIBILITIES:

• Supervises a team of medical billers, authorization staff and credentialing staff to ensure all credentialing, authorizations and billing and collection processes are current and up to date.

• Oversees and ensures the Electronic Health Record (EHR)is configured and operating per payer regulations

• Ensures insurance is verified and accurate in the EHR. Use the 270/271 eligibility files at the beginning of the month

• Works with program staff to ensure current consumer information and status are entered in the EHR accurately and maintained for collection, services offered, and BHSD reporting.

• Works with program staff to ensure that authorizations are current and requests supplemental units as needed.

• Ensures pre-billing reports are cleared before billing for the week. These reports must be zeroed out by month and year-end.

• Supervises the process of extracting, posting, reviewing, and transmitting complete Medicaid billing for all programs.

• Reconciles and confirms all billing reports received with the services performed and claims transmitted. Addresses any problems with rejected 837p files and resubmits files once corrected.

• Identifies and analyzes problems and implements solutions as needed or instructed.

• Ensures all payments are posted within the month the payment is received; all denials must be worked in the month received. Approves any write-offs or adjustments.

• Performs a hard close in EHR. Provides program leadership and accounting staff with financial reports for revenue recognition, AR reconciliations, adjustments, and payments received by the 10th of the month.

• Assists in audits, including but not limited to yearly financial audits and payer claims audits.

• Works with the Compliance team to enforce internal and payer regulations.

• Works with Program staff to ensure that Providers are compliant with licensure and credentialing requirements to successfully bill for services rendered.

• Monitors the accounts receivable to ensure that billing, appeals and claim corrections are filed and completed within federal and MCO time limits to resolve all outstanding claims.

• Maintains open communications with all related staff to facilitate and resolve billing issues and problems and any denied claims. Initiates meetings with staff as needed.

• Develops and maintains open communications and positive relationships with community resources and agencies as needed to effect and enhance the billing process.

• Maintains current knowledge of the billing process and state and local billing procedures.

• Maintains working knowledge of the VOACC Policies and Procedures and program procedures as related to operations, services, and billing.

• Responsible for keeping required records of service-related items in conjunction with finance.

• Attends staff and organizational meetings as required.

• Performs other duties as assigned.

PHYSICAL REQUIREMENTS:

The physical requirements described below are representative of those that must be met by an employee to successfully perform the essential duties of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties.

• The ability to safely operate a motor vehicle to transport oneself, consumers, and program supplies as necessary.
• The physical ability to travel to assigned locations, stand, stoop, bend, reach, pull, push, lift, grasp, climb, talk, see, hear and perform basic and light home maintenance activities and operate office equipment.
• Operating office equipment requiring continuous or repetitive hand/arm movements.
• The ability to remain in a sitting position for extended periods of time

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. 

REQUIREMENTS

• Bachelor’s degree in healthcare administration or related field. Master's preferred.

• Minimum five years of experience working with Medicaid payments, private insurance or revenue cycle

• Minimum three years of experience managing staff and goal setting/development.

• Detailed experience in behavioral health along with hospital setting is a plus.

• Preferred certification as a Certified Professional Coder (CPC), Certified Professional Biller (CPB), or Certified Coding Specialist (CCS)

Work Experience

• Specialized training in Medicaid or healthcare billing procedures and revenue cycle

• Ability to create parameters for accuracy of claims, rectify trend errors and provide solutions for timely processing of claims.

• Experience with coordination of workflow, supervision, and training of new or existing staff and change management regarding processing of payments and aligned procedures.

• Experience with appeals and reconciliation of billing coding errors for reimbursement

• Experience with management of teams, goal setting, benchmarks and KPI matrices.

Soft Skills

• Keen attention to detail, multitasking, meeting deadlines, flexibility to work with different aspects of the organization and other program leaders and support units.

• Ability to research, prepare, maintain, and review reports and documentation with timeliness and accuracy. 

• Strong problem-solving and execution skills.

• Cultural responsiveness with an ability to work with individuals from diverse backgrounds.

• Excellent written and verbal communication skills;

Technology

• Experience with Microsoft Office (Word, PowerPoint, Excel, Outlook)

• Experience with Credible Software, preferred, Practice Management Systems and 3rd Party Clearinghouses

• Ability to understand various technology systems and general office resources.

• Excellent organizational and execution skills.  

• Bilingual in any language is a plus.