SUPERVISOR : Chief Operating Officer HOURS : M-F 8-5, Some Sat. 9-12, must be flexible
CLASSIFICATION : Full time / Salaried / Exempt TRAVEL / LOCATION : Barton
QUALIFICATIONS :
- Bachelor's degree in business, Finance, Healthcare Administration or equivalent and minimum of five (5) years of medical billing / coding experience.
- Minimum of three years in a supervisory role.
- Knowledge of professional fee billing, reimbursement and third-party payer regulation and medical terminology is required.
- Medical coding certification required.
- Demonstrated FQHC coding, billing and revenue cycle management knowledge / experience preferred
- Medent experience and EHR system knowledge preferred.
- Experience with MCVR and AHCF cost reports preferred.
JOB SUMMARY : Working under the direction of the Chief Operating Officer, the Director of Reimbursement Management, will lead the organizations insurance contract negotiations across all service lines working collaboratively with some Directors and Chiefs to collaboratively support and prioritize key contracts for negotiations. The Director of Reimbursement Management will oversee the Billing & Facilitated Enrollers teams, Credentialing team and lead in efforts to streamline provider billing through trainings, ensuring that the organization stays ahead of all regulatory changes in reimbursement models. This will involve leveraging various tools focused on improving people, processes, and technology. The Director of Reimbursement Management will support the COO in providing leadership to the Billing / Facilitated Enrollers teams and the Credentialing team. The successful candidate will be responsible for overseeing the Billing and Coding Manager, who will ensure that accounts receivable is maximized, and billing workflows are efficient, while also identifying areas for process improvement. The ideal candidate will be analytical, have exceptional organizational skills, and thrive in a team environment. The successful candidate will oversee the Billing and Coding Manager who will ensure that account receivables are maximized, and billing workflows are efficient, while identifying areas for process improvement. The ideal candidate will be analytical, have exceptional organizational skills, and thrive in a team environment.
Essential Job Duties
MANAGEMENT OF REIUMBURSEMENT
Manage and negotiate insurance contract rates annually across all service lines where appropriate working with the Chief Compliance Officer.Research opportunities provided by supervisor or Executive Team that will enable the organization to have increased reimbursement streams.Support the annual audit and any additional regulatory reporting needs as they relate to revenue.Partner with leadership to review and understand key inputs within the revenue recognition process, including obtaining knowledge of various billing systems, auditing procedures, and reports to recommend and construct revenue recognition.Support the reporting of monthly statistical analysis, including hosting variance meetings with operations to understand current trends and future impacts.Conduct complex analysis on service lines to inform the financial strategies to maximize net revenues.Manage and monitor billing and collection processes, operations and controls, ensuring all billing and payment cycles are accurate and timely, in accordance with established internal third-party payer requirements and established JRCHC (Jericho Road Community Health Center) policies.Maintain, analyze and report on key revenue metrics and departmental and payer revenue performance indicators, proactively communicating and solving revenue related issues; Identify trends for further review.Serve as a liaison between finance department and clinical departments on billing and revenue cycle matters; Enhance awareness of providers on ways to strengthen revenue cycle performance; Train staff on ways to improve revenue generation efficiencies.Request, prepare and or maintain reports on billing and collections activities; Develop monthly summary reports for the chief operating officer and senior leadership.In conjunction with the Billing manager, educate clinical staff including medical site directors and office managers on updates related to medical billing.Perform routine assessments for timely billing processes and optimal collection ratios, providing reports to the chief operating officer and chief financial officer where appropriateEstablished key collaborative relationships with Medicaid managed care organizations and insurance companies to solve problems and improve reimbursement rates and timeliness.Support billing manager and his or her efforts to work closely with IT (Information Technology) and the EHR team to design systems to maximize reimbursement from third party insurers, and monitor performance including denials, under payment, adjustments and collections.Establish and implement annual goals for billing functions that align with JRCHC's vision and business goals identifying external benchmarks.Maintain up-to-date expertise and knowledge of health care billing, laws rules, regulations and developments necessary for the organization to make informed business decisions.Establish, maintain and evaluate policies and procedures for the billing office to meet the goals of the fiscal budget.Participate in the development and implementation of corrective action plans to address department and operational deficiencies.Responsible for timely completion of all departmental quality assurance reports.Communication liaison between the billing department and the clinical staff.Attend and participate in senior leadership meetings as required.Coordinates routine departmental meetings and supplies meeting summaries promptly to the COO and other executive team members where appropriate.Adhere to guidelines and detection protocols for fraud, waste and abuse with Director of Compliance and Risk Management.Identify patient reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed, and resolve billing-related issues.Ability to code diagnoses and procedures correctly and to train others as needed.Sound knowledge of health insurance providers, able to navigate different carriers and individual plans more specifically in the FQHC world.Oversee monthly close processes, including reporting and account balancingReview financial hardship applications and manage the organization's sliding fee pay scale program compliance in accordance with HRSA (Health Resources and Services Administration) and organization policies and procedures in collaboration with the Chief Compliance Officer.Coordinate billing and collection activities, maximizing payments and improving our processes.Address medical billing denials from an insurance provider, removing barriers so that patients may be cleared to receive treatment.Ensure compliance with HIPAA (Health Insurance Portability and Accountability) and other relevant healthcare regulations.Support the investigation, remediation, and de-escalation of claims related customer issues.Conduct complex analysis on assigned operating units' revenue to inform the development of financial strategies to maximize net revenues.CREDENTIALING
Monitor and manage continuous credentialing compliance in accordance with regulatory bodies and JRCHC policies and procedures.Monitor the daily performance of the Credentialing Manager to maintain credentialing status for all the privileged staff of JRCHC.Establish and evaluate policies and procedures for credentialing to ensure that the organization's goals are met.Remain up to date on all credentialing procedures in accordance with HRSA compliance and payer guidelines.SUPERVISION
Provide supervision, guidance and consultation to the Billing Manager and the Credentialing Manager as they supervise and oversee the respective teams under them.Provide supervision and oversee the day-to-day work of the facilitated enrollers.Support the Billing Manager and Credentialing Manager in conducting staff performance by providing regular feedback, 30, 60, 90 day and annual evaluations.Support Managers with hiring and training staff, with Human Resources teamApprove payroll and staff time off with attention to scheduling for appropriate staffing.Conduct one-on-one meetings with staff and team meetings as needed.Ensure compliance with training for new staff members and annual training for all team members under your supervision with the Director of Talent Development.The person in this position should be able to demonstrate daily a commitment to the organizational mission, vision, and values of JRCHC.
Our Mission : We care for our communities and advocate for systemic health equity to demonstrate the unconditional love of Jesus.
Our Vision : Our vision is for individuals, families, and communities to become healthy and whole.
Core Values : We strive to foster faith and hope in ourselves and in our clients. We consider body, mind, spirit, and relationship with God, others, community, and self as components of health.
Community : We partner with and listen to our communities to inform our services, build sustainability, and foster interconnectedness. We believe in serving one another; including our patients, clients, residents, and team members, through fellowship and compassion.Equity : We uphold dignity, serve as advocates, and pursue justice to elevate the quality of comprehensive health for individuals and communities. We embrace and celebrate diversity.Integrity : We demonstrate humility, honesty and transparency in our practices and interactions. We hold ourselves to the highest standards and evidence-based quality care, consistently learning, growing, and developing to serve our communities and one another wholeheartedly.Individuals who hold positions at Jericho Road Community Health Center should possess the following qualification and capabilities :
Passion for serving individuals personal and community developmentExcellent verbal and written communication skillsExperience working with EMR, Medent preferredProject-management experienceStrong organizational skills and attention to detailProficiency in Microsoft Office programs or willingness to learnCreativity and problem-solving capabilitiesPositive and engaging interpersonal skillsStrong self-motivationAbility to travel between sites if necessary to serve multiple locationsExperience working with low-income, diverse, multilingual populations highly desiredAble to interpret, adapt, and apply guidelines and proceduresMust be self-motivated and able to function independently and in teams at all levelsStrive to serve various communities and socioeconomic statuses in a culturally competent wayAttend required training as deemed mandatory by organization or to continue education in fieldDemonstrate flexibility as new tasks are added by supervisor or position evolves over timePHYSICAL REQUIREMENTS : Must be able to sit or stand for long periods of time. Exert up to 50lbs. pushing, pulling, or lifting. Walking and climbing stairs required. Able to talk / hear and communicate with others with or without reasonable accommodation.
TRAVEL REQUIREMENTS : Must be able to travel to sites while maintaining standards of safety and compliance with motor vehicle traffic laws. This position may require travel for necessary training and conferences.
