Director of Reimbursement Operations

1 month ago


Wytheville, Virginia, United States Mount Rogers Community Services Full time
Job Summary

The Director of Reimbursement is a key leadership position responsible for overseeing the Agency's billing department. This role involves planning, organizing, and managing the operation of the billing department to ensure revenue maximization from Medicaid, Medicare, and other third-party payers.

Key Responsibilities
  1. Manage and oversee the Agency's computerized billing of third parties, including Medicaid, Medicare, commercial insurances, and individuals served.
  2. Monitor governmental and commercial insurance reimbursement regulation changes to ensure compliance and optimize payments.
  3. Review and maintain all contracts with third-party billers, negotiate with them to obtain best revenue maximization for the Agency.
  4. Communicate with office and direct care staff regarding existing and changing regulations, research topics, and troubleshooting issues.
  5. Provide training and guidance to staff in resolving difficult account issues and preventing denials and non-payment.
  6. Analyze reports, monitor and analyze revenue trends, examine and identify patterns of rejections or denials from third-party payers, and implement solutions for reimbursement issues and revenue enhancement methods.
  7. Support Agency management in long-range planning efforts regarding reimbursement issues in response to Agency growth.
  8. Supervise staff in the billing department to ensure billing is generated in a timely manner and follow-up on denials and/or rejections with funding sources.
Requirements
  • Strong attention to detail
  • Good written and oral communication skills
  • Research and analysis skills
  • Report preparation and documentation skills
  • Ability to train other team members
Qualifications
  • Bachelor's degree in Accounting, Business, Management, or a related field
  • Five years' experience in management of reimbursement activities
  • Two years' experience in a progressive supervisory role managing a team of several members
  • Knowledge of and prior experience with Medicare, Medicaid, and commercial insurance billing and collections

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