Director of Reimbursement Services

2 weeks ago

Conshohocken, United States Extremity Care Full time

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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