Director, Medicaid Billing and Revenue
The Director of Medicaid Billing and Revenue reports to the Chief Financial Officer and is responsible for ensuring timely and accurate processing and transmitting of claims for federal and nationwide Managed Care Option (MCO) Plans, including grant funding, managing consumer records and accounts, monitoring utilization of services. Coordinates systems utilization for multiple lines, ensures data entry of record service hours with billing clerk and provider staff, develops appropriate and complete bills, transmits bills through systems carrier and reconciles funds collected with all billed claims ensuring accuracy, completeness and accountability. In addition, the Director is responsible for informing and training appropriate staff on any new billing procedures, ensuring that the credentialing and compliance policies, practices and procedures are followed.A' Will work closely with the Regional Vice Presidents and Finance to ensure that the programs are meeting the requirements of Medicaid and local funding sources' billing standards, and the programs accurately maintain required financial files of the individuals served. RESPONSIBILITIES: Supervises a team of medical billers to ensure all billing and collection process are current and up to date. Oversees and ensures the electronic billing system is set up and operating properly. Implement, track and monitor policy and procedures for insurance verification standards and requirements Works with the program staff to ensure current Individual's information and status is entered in the system accurately and maintained for collection and services offered. Ensures records of service hours are accurately entered in the system for each individual in eachA' A' program.A' A' EnsuresA' A' all billableA' A' hours/claimsA' A' are accountedA' A' for, reporting omissions or discrepancies. Extracts, posts, reviews, and transmits complete Medicaid billing for all programs. Reconciles and confirms all billing reports received with the services performed and claims transmitted. Report problems or discrepancies. Identifies and analyzes problems and implements solutions as needed or instructed. EnsuresA' A' re-billingsA' A' are completedA' A' as appropriateA' A' and that all MedicaidA' A' billings (DDSIDOH) are complete and finalized within a scheduled time of ramA' A' Electronic Forwards of checks with correct coding information to accounts receivable. Manages and keeps records of all individual funds as required. Maintains open communications with all related staff to facilitate and resolve billing issues and problems any denied claims. Initiate meetings with staff as needed. Develops and maintains open communications and positive relationships with community resources and agencies as needed to effect and enhance the billing process. Maintains current knowledge of the billing process and state and local billing procedures. Maintains working knowledge of the VOAC Policies and Procedures and program procedures as related to operations, services and billing. ResponsibleA' A' for keeping required records of service related items in conjunction with finance. AttendsA' A' staff and organizationalA' A' A' meetingsA' A' as required. Performs other duties as assigned. PHYSICAL REQUIREMENTS: The physical requirements described below are representative of those that must be met by an employee to successfully perform the essential duties of this job.A' Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties. The ability to safely operate a motor vehicle to transport oneself, consumers, and program supplies as necessary. The physical ability to travel to assigned locations, stand, stoop, bend, reach, pull, push, lift, grasp, climb, talk, see, hear and perform basic and light home maintenance activities, and operate office equipment. Operating office equipment requiring continuous or repetitive hand/arm movements. The ability to remain in a sitting position for extended periods of time OTHER DUTIES: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.A' REQUIREMENTS Bachelor's Degree in Healthcare Administration or related field. Masters preferred. A' Minimum (5) five years of experience working with Medicaid payments or revenue cycle Minimum (3) three years of experience managing staff and goal setting/development. Detailed experience in behavioral health along with hospital setting is a plus. Preferred certification as a Certified Professional Coder (CPC), Certified Professional Biller (CPB), or Certified Coding Specialist (CCS). Work Experience Specialized training in Medicaid or healthcare billing procedures and revenue cycle Ability to create parameters for accuracy of claims, rectify trends errors and provides solutions for timely processing of claims. Knowledge of appeal process of federal carriers and MCO's maximize revenue. Experience with coordination of workflow, supervision and training of new or existing staff and change management regarding processing of payments and aligned procedures. Experience with appeals and reconciliation of billing coding errors for reimbursement Experience with management of teams, goal setting, benchmarks and KPI matrices. Soft Skills Keen attention to detail, multitask, meet deadlines, flexibility to work with different aspects of the organization and other program leaders and support units. Ability to research, prepare, maintain and review reports and documentation with timeliness and accuracy.A' Strong problem solving and execution skills. Culturally responsiveness with an ability to work with individuals from diverse backgrounds. Excellent written and verbal communication skills; Technology Experience with Microsoft Office (Word, Power-point, Excel, Outlook) Ability to understand various technology systems and general office resources. Excellent organizational and execution skills. A' Bilingual in any language a plus.