Director of Federal, MCO Revenue Cycle Management

🕒 3 dias atrás

🦀 Maryland – Remoto

🦀 Maryland – Remote

💵 $110.000 - $120.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Volunteers of America Chesapeake & Carolinas

SiteLinkedInTodas as Vagas

501 - 1000 funcionários

Fundada em 1896

🤲 Filantropia

🏥 Saúde

🌍 Impacto Social

Charity • Healthcare • Social Impact

A Volunteers of America Chesapeake & Carolinas é uma unidade regional da organização sem fins lucrativos Volunteers of America, que oferece serviços de moradia, saúde e assistência social a pessoas e famílias em situação de vulnerabilidade em Maryland, Virgínia, no Distrito de Columbia e nas Carolinas. A missão da organização é promover a autonomia, a dignidade e a esperança por meio de programas que incluem serviços para pessoas em situação de rua e moradia assistida, serviços de saúde mental, recuperação do uso de substâncias, atendimento a pessoas com deficiências intelectuais e do desenvolvimento, serviços para veteranos, reinserção comunitária e desenvolvimento profissional. A VOACC administra diversos programas locais, eventos e parcerias comunitárias para conectar seus beneficiários a moradia, atendimento de saúde e redes de apoio social.

Descrição

• Manage the entire revenue cycle, including eligibility, authorizations, contracting and credentialing, claims billing, collections, rejections and denials management, fiscal reporting, and reconciliations • Report to the VP Finance • Supervise medical billers, authorization staff, and credentialing staff • Ensure EHR configuration and operation comply with payer regulations • Verify insurance and maintain accurate consumer information in the EHR • Use 270/271 eligibility files at the beginning of the month • Ensure authorizations are current and request supplemental units as needed • Clear pre-billing reports before weekly billing and month/year-end close • Supervise Medicaid billing extraction, posting, review, and transmission • Reconcile billing reports with services performed and claims transmitted • Resolve rejected 837p files and resubmit corrected files • Post payments within the month received and work denials within the month received • Approve write-offs and adjustments and perform hard closes in the EHR • Provide financial reports for revenue recognition, accounts receivable reconciliations, adjustments, and payments by the 10th of each month • Assist with yearly financial audits and payer claims audits • Enforce internal and payer regulations with the Compliance team • Ensure providers meet licensure and credentialing requirements for billing • Monitor accounts receivable, appeals, and claim corrections within federal and MCO deadlines • Communicate with staff to resolve billing issues and denied claims; initiate meetings as needed • Maintain relationships with community resources and agencies • Maintain knowledge of billing processes and state/local billing procedures • Maintain knowledge of VOACC and program policies and procedures • Keep required service-related records with Finance • Attend staff and organizational meetings and perform other assigned duties • Travel to assigned locations and operate office equipment as required

🎯 Requisitos

• Bachelor's Degree in Healthcare Administration or related field • Minimum five years of experience working with Medicaid payments, private insurance or revenue cycle • Minimum three years of experience managing staff and goal setting/development • Specialized training in Medicaid or healthcare billing procedures and revenue cycle • Ability to create parameters for claim accuracy, rectify trend errors, and provide solutions for timely claim processing • Experience coordinating workflow, supervising, and training new or existing staff and managing change related to payment processing and procedures • Experience with appeals and reconciliation of billing coding errors for reimbursement • Experience managing teams, goal setting, benchmarks, and KPI matrices • Ability to research, prepare, maintain, and review reports and documentation accurately and timely • Strong problem-solving and execution skills • Cultural responsiveness and ability to work with individuals from diverse backgrounds • Excellent written and verbal communication skills • Microsoft Office: Word, PowerPoint, Excel, Outlook • Experience with Credible Software, Practice Management Systems, and third-party clearinghouses • Ability to understand various technology systems and general office resources • Ability to operate a motor vehicle and travel to assigned locations • Preferred: Master's degree • Preferred certification as CPC, CPB, or CCS • Bilingual in any language a plus

🏖️ Benefícios

• Plus benefits