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Director of Revenue Operations

2 months ago

Wytheville, Virginia, United States Mount Rogers Community Services Board 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 efficient and effective revenue maximization from various payers, including Medicaid, Medicare, and commercial insurance companies.

Key Responsibilities
  • Supervise the preparation of claims and ensure timely submission to payers.
  • Responsible for resolving critical and complex billing issues, including denials and rejections.
  • Analyze reports and identify patterns of rejections or denials from third-party payers to implement solutions for reimbursement issues and revenue enhancement methods.
  • Develop and implement process improvements and operational changes to optimize billing efficiency.
  • Manage quality assurance initiatives for billing purposes and work closely with data administration and management.
  • Supervise reimbursement staff and provide training to ensure compliance with payer regulations.
  • Monitor governmental and commercial insurance reimbursement regulation changes to ensure Agency compliance.
  • Review and maintain all contracts with third-party billers and negotiate to obtain best revenue maximization for the Agency.
  • Communicate with office and direct care staff regarding existing and changing regulations, research topics, and troubleshooting of issues.
  • Provide training and guidance to staff in resolving difficult account issues and to help prevent denials and non-payment.
  • Write, review, and maintain business documents, including reports, contracts, manuals, and procedures.
  • Responsible for credentialing of Agency's licensed staff, including requesting confidential information and/or materials from staff, making application, and serving as liaison with insurer.
  • Analyze reports, monitor and analyze revenue trends, and examine and identify patterns of rejections or denials from third-party payers.
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.