Director Provider Billing Group

Found in: beBee S US - 3 weeks ago

San Francisco, United States Department Of Health And Human Services Full time
Summary

This position is located in the Center for Medicare, Centers for Medicare and Medicaid Services (CMS).

As the Director, you will provide executive leadership, direction and coordination for the Provider Billing Group (PBG). The position provides executive direction to activities necessary to ensure the successful completion of planning, and implementation of program management for the operational policies and budget guidelines for claims processing in the Medicare fee-for-service (FFS) program.



Duties
  • Leads and directs the development of the requirements, methods, standards, policies, procedures, and budget guidelines for Medicare FFS claims processing related activities.
  • Provides operational expertise to the development and implementation of Agency policies, regulations, procedures, new payment models and legislative proposals, taking into consideration the impacts on affected stakeholders and business processes.
  • Coordinates modifications to existing operational procedures, contracts, and related materials, as required. Recommends alternatives to existing processes, policies, and procedures, as well as methods of improvement.
  • Identifies and reacts to deficiencies in Medicare FFS claims processing requirements and develops instructions and guidelines for proper claims processing, including findings identified in OIG and GAO reports.
  • Directs the development and release of pricing software and files used in Medicare FFS claims processing for institutional, professional and supplier claims, including Pricers, fee schedules, and coding files.
  • Directs the development of data analysis programs and software modules necessary to support Medicare FFS payment policy development.

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