Director of Reimbursement Services

Purpose

The Director of Reimbursement Services is responsible for overseeing the reimbursement operations and revenue cycle management.

Duties & Responsibilities:

• Provides leadership and knowledge to internal teams and external customers on reimbursement and claims to maximize revenue and minimize denials
• Monitors, evaluates and reviews all cost reporting in support of reimbursement claims
• Develops policies and procedures compliant with regulatory requirements
• Oversees the collection of statistical and financial data needed for preparing reporting
• Conduct education of products to internal and external customers
• Develops training programs and makes formal presentations on the billing process and support services
• Administers coding, billing, and coverage guidelines to reimbursement team, sales and provider accounts
• Identify policy issues, implement third party reimbursement changes and communicate with Medicare contractors and commercial payers regarding medical policy and coverage guidelines
• Lead reimbursement staff training and identify issues affecting reimbursement and provide solutions
• Provide direction on payer strategy
• Manage key relationships with providers, payers, sales force, and reimbursement team.
• Coach others on current regulatory information and guidelines
• Communicates relevant changes and protocol and procedural revisions to senior management and staff
• Implements appropriate departmental operations changes to ensure compliance
• Ensures department promptly and professionally carries out resolving issues relative to customer and reimbursement services
• Evaluates payer reimbursement and trends to identify deficiencies, mitigate revenue issues and opportunities for improving payment rates and reducing denials
• Provides oversight of underpayment and denial management of claims
• Identifies opportunities for improvement based on organizational needs and industry standards
• Promotes culture of continuous improvement

Skills & Abilities:

• Solid analytical and financial management skills
• Strategic planning and leadership within healthcare settings
• Exceptional interpersonal skills and ability to interact with a range of internal and external customers
• Excellent communication skills, including listening, writing, and presenting to groups of all sizes
• Ability to work collaboratively with proficient team building skills

Education & Experience:

• Bachelor\'s Degree in Health Administration, Finance, Business Management or related field
• 7 plus years of healthcare reimbursement management experience
• Proficient knowledge of current regulatory information/guidelines
• Healthcare law and financial management experience
• Extensive knowledge of Medicare, managed care plans, and medical billing and coding
• Proven track record of developing and implementing successful reimbursement strategies
• Deep understanding of payer policies and patient billing practices