Director of Public Healthcare and Payor Compliance

Job Description

Reporting to the Vice President of Revenue Cycle Management, and with strong collaboration with the Legal Team, this position is responsible for ensuring the Company maintains compliance with all Federal, State and Commercial reimbursement contracts and programs and provides regular updates to management regarding existing compliance requirements and changes in the regulatory environment. Further, this position will also be responsible for compliance functions related to Medicare and Medicaid compliance within the Company, including managing and responding to all audit inquires of governmental entities and commercial payors.

Essential Duties

• Obtain and maintain all required federal & state licensing required for product reimbursement.
• Own accreditation activities of KMTS as required by federal and state programs.
• Conduct file audits by region and payor (quarterly rotations) to include reporting of results and follow-up training as required. Present findings to the Compliance Committee.
• Review all payor contracts and ensure that KMTS meets all designated requirements in the areas of reimbursement including, but not limited to, internal audits, third-party service arrangements, timely filing, and claim reporting. This information will be shared with the various responsible departments within KMTS.
• Develop a database of payor policy and billing guidelines to support all KMTS functions involved in reimbursement.
• Manage the maintenance of payor contract requirements to include both reporting and renewal requirements Including regular reporting of contract compliance status. Including regular reporting of contract compliance status.
• Oversee the initial submissions and renewals of all state Medicaid programs and monitor continuing compliance with such programs.
• Monitor trends in regulatory policies, through attendance with Payor & Regulatory meetings (continue membership with AAH Regulatory committee and Medicare Jurisdiction Councils) and report findings to management.
• Develop and maintain Reimbursement training programs in collaboration with other stakeholders.
• Manage all federal, state and commercial payor audits.
• Collaborate with the product development team in the area of coding, policy and funding of new products.
• Manage all new and renewals of payor credentialing.
• Adhere to Pledge of Confidentiality
  
  

COMPETENCIES

• Passion: Contagious excitement about the company sense of urgency. Commitment to continuous improvement.
• Integrity: Commitment, accountability, and dedication to the highest ethical standards.
• Collaboration/Teamwork: Inclusion of Team Member regardless of geography, position, and product or service.
• Action/Results: High energy, decisive planning, timely execution.
• Innovation: Generation of new ideas from original thinking.
• Customer Focus: Exceed customer expectations, quality of products, services, and experience always present of mind.
• Emotional Intelligence: Recognizes, understands, manages ones own emotions and is able to influence others. A critical skill for pressure situations.
• Ability to be a self-starter, seek new and better methods, and work with minimum supervision.
• Demonstrates deep expertise in profession and industry best practices.
• Ability to collaborate within a Team environment and across functions.
• Capability to discern relevant facts and in turn, effectively resolve issues by making good decisions (compliance, quality, integrity, ethics, and critical thinking ability).
• Ability to be flexible in a fast-paced goal-oriented environment.
• Demonstrates the understanding of deadlines and time limits, ability to accomplish goals, and the desire to win.
  
  

Qualifications

EDUCATION/EXPERIENCE REQUIRED:

• Bachelors degree
• At least 15 years of experience in DME Reimbursement field policy, funding & billing
• Advance knowledge/proficiency in government (Medicare/Medicaid) regulations and Commercial Insurance
• Contracts, as required.
• Strong background in financial management and knowledgeable of federal and state laws and requirements relating to healthcare/governmental regulations.
• Proficiency with Bonafide, Microsoft Office Word, Excel, and PowerPoint preferred
  
  

Preferred

• Masters degree
  
  

Why Is This a Great Opportunity

Work for a company that make a difference in patients' lives. Making a difference is key to who they are.