Director of Federal, MCO Revenue Cycle Management

🔥 7 minutes ago

🦀 Maryland – Remote

🦀 Maryland – Remote

💵 $110k - $120k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 0%

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Volunteers of America Chesapeake & Carolinas

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1896

🤲 Charity

🏥 Healthcare

🌍 Social Impact

Charity • Healthcare • Social Impact

Volunteers of America Chesapeake & Carolinas is a regional branch of the Volunteers of America nonprofit that provides housing, health, and human services to vulnerable individuals and families across Maryland, Virginia, the District of Columbia, and the Carolinas. The organization’s mission is to inspire self-sufficiency, dignity, and hope by offering programs including homeless services and supportive housing, mental health services, substance use recovery, services for people with intellectual and developmental disabilities, veteran services, community re-entry, and workforce development. VOACC runs multiple local programs, events, and community partnerships to connect clients with housing, healthcare, and social supports.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• Plus benefits