Director of Reimbursement Services

3 weeks ago

Conshohocken, United States Extremity Care Full time
Job DescriptionJob DescriptionSalary:

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

 


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