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Associate Director, Payer Reimbursement

3 months ago


Tarrytown, United States Winston Staffing Services Full time
Job DescriptionJob Description

Associate Director, Payer Reimbursement
Location: Hybrid (Onsite in Tarrytown, NY)

Job Summary:
Winston is seeking an experienced and dynamic Associate Director, Payer Reimbursement (AD). The AD will be responsible for overseeing and managing the payer reimbursement operations for our hospital services. This role requires a strategic thinker with strong leadership skills to ensure financial control, timely and accurate payments, and the effective management of accounts receivable. The ideal candidate will work collaboratively with internal and external stakeholders to optimize cash flow, improve workflows, and enhance operational efficiency.

Key Responsibilities:

  • Operational Management:

    • Plan, direct, coordinate, and control the payer reimbursement operations for hospital services.
    • Oversee the collection and re-bill activities to ensure timely and accurate payments.
    • Collaborate with Payer Managers and the Senior Director of Revenue Realization to identify and implement performance improvement strategies.
  • Team Leadership:

    • Manage and oversee the output and quality of all payer accounts receivable within your scope.
    • Provide AR analysis and create written processes and procedures.
    • Identify and implement required training for Revenue Realization staff.
  • Collaboration & Communication:

    • Work interdependently with other departments to create improved workflows and efficiencies that impact patient revenue.
    • Maintain and improve relationships with internal and external customers.
    • Present information in a clear, concise manner and interact with patients professionally.
  • Specialized Oversight:

    • Manage and oversee the following key tasks:
      • Weekly Metrics Call
      • Vendor Management
      • Monthly Quality Performance
      • 365+ AR Review
      • Payer Escalation Protocol management
      • Coding/Billing/DNFB Edits
      • EPIC Training and Work Queue Management
      • Annual/Bi-Annual Policy Review
      • Denials Huddle Collaboration
      • Monthly Transplant Case Review

Qualifications:

  • Certifications:

    • CRCR (Certified Revenue Cycle Representative) from HFMA or
    • CRCP (Certified Revenue Cycle Professional) from AAHAM highly preferred.
  • Experience:

    • Healthcare business office experience in areas such as accounts receivable, collections, billing, financial counseling, etc., preferred.
    • Familiarity with HIPAA compliance, coding, charging, and billing is essential.
    • Experience with Epic systems is preferred.
  • Skills:

    • Excellent communication, organization, and problem-solving skills.
    • Strong written and verbal communication abilities.
    • Ability to discuss billing, collections, and charging matters with confidence.
    • Proficiency in presenting information clearly and concisely.
    • Working knowledge of CPT, ICD-9/ICD-10 coding, and Federal/managed care regulations preferred.
    • Proficiency in Excel, Word, and PowerPoint is required.