What are the responsibilities and job description for the Associate Director, Reimbursement Operations position at Pro-Spectus LLC?
Job Description
Job Description
The Associate Director Reimbursement plays a critical leadership role in managing and optimizing the reimbursement process supporting the financial and operational goals of the programs and services offered by the organization. This individual is responsible for ensuring seamless reimbursement operations including claims management, denial management, payor contract negotiations, and patient financial assistant programs.
Core Duties / Responsibilities :
- Oversee the entire Accounts Receivable cycle, including the submission and processing of claims. Ensure accuracy, timeliness, and compliance with regulatory requirements through the AR cycle and collaborate with internal and external stakeholders to resolve issues related to reimbursement.
- Responsible for overseeing and optimizing reimbursement strategies ensuring compliance with payor policies and driving operational efficiencies in claims management.
- Develop and implement strategies to maximize reimbursement and reduce revenue leakage.
- Analyze reimbursement trends, identify opportunities, and make recommendations for continuous process improvement.
- Ensure adherence to all state and federal healthcare regulations including CMS guidelines and payor specific requirements.
- Monitor claim denials and work with the team to resolve issues while collaborating with external stakeholders such as insurance providers and government agencies to resolve any reimbursement-related issues.
- Collaborate with internal departments to drive alignment on reimbursement initiatives.
- Act as a liaison between the organization and key stakeholders : Collaborate with healthcare providers, billing departments, and insurance companies to resolve reimbursement-related issues.
- Keep abreast of codes, fee schedules, and changes in reimbursement guidelines and adjust processes accordingly.
- Provide strategic direction, daily oversight, and mentorship to the reimbursement team fostering a high-performance culture.
- Coaching and development of new hires
- Additional responsibilities include but are not limited to work performance review, training, ongoing coaching, and planning for team coverage needs.
Skills / Requirements
Education, Certifications and Experience :
Bachelor's degree in healthcare administration, business, or a related field.
P hysical Requirements :
Our PRO-Spectus Culture Philosophy
At PRO-Spectus we have created a culture that is supportive, dedicated, and teamwork driven. We celebrate each other’s joys in personal life and professional accomplishments, promoting meaningful relationships and friendships.
Our employees bring strength of mind and spirit to make the extraordinary happen every day. With humility and compassion at our core, PRO-Spectus is proud of our relentless focus towards the higher purpose of improving the lives of patients we support.
We recognize it takes a lot of people working together with a common goal to make spectacular happen, and we never forget that at the heart of our company are the people who make it work.
PRO-Spectus is an Equal Opportunity / Affirmative Action employer. All qualified individuals will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, ancestry, age, disability, protected veteran status, marital status or other protected status under federal, state or local laws.
At PRO-spectus, we are deeply committed to pay transparency and equity. The salary range for this position is $110,000-$135,00 based on experience and qualifications, with the final offer reflecting skills and other job-related factors. Beyond competitive pay, we offer a comprehensive and generous benefits package designed to support your well-being and work-life balance.
Our benefits include robust medical, dental, and vision plans; life insurance and disability coverage; and tax-advantaged savings accounts. We also provide an Employee Assistance Program, home office benefits, and unique perks like an Employee Ownership Program. With paid time off, holidays, bereavement leave, and a 401(k)-retirement plan with employer matching, PRO-spectus prioritizes your financial and personal security. Plus, you may be eligible for a performance-based bonus opportunity.
Join PRO-spectus, where your career growth, well-being, and contributions truly matter!
Salary : $110,000
