Director of Reimbursement Job in Buffalo 14202, New York US

With more than 20 years as a multi-regional leader in the home health care field, WILLCARE provides a supportive environment and the flexibility to our professionals that enables them to have real work-life balance. We combine the best in healthcare technology with a customized, caring approach to each patient.

 

POSITION SUMMARY:

 

The Director of Reimbursement is primarily responsible for directing the claims and provider reimbursement process. The claims and provider reimbursement includes billing operations, medical coding, and insurance authorization.  The Director of Reimbursement will coordinate the overall functions of the billing, medical coding and insurance authorization departments to ensure maximization of cash flow.

 

ESSENTIAL DUTIES RESPONSIBILITIES for position:

  1. Plans, directs and monitors the activities of the insurance authorization, medical coding, billing departments to ensure accurate patient billing and optimal reimbursement. Monitors daily operating activity these departments and makes necessary adjustments in work assignments to maintain accurate patient billing, optimal reimbursement, and superior customer relations.
  2. Assess the impact of regulatory reimbursement changes; research reimbursement of new programs / services; and make recommendations strategies to maximize agency reimbursement.
  3. Ensure that all billing is in compliance with all appropriate laws and regulations.
  4. Ensure the appropriate diagnostic and procedural codes are used in medical coding.
  5. Ensure that insurance authorizations are secured for all managed care cases in a timely thorough manner to maximize timely billing and prevent bad debt.
  6. Verify and analyze rate calculations and final cost settlements submitted by third party payers and governmental agencies for accuracy.  Prepare calculations which project estimated rates of reimbursement.  Utilizes these projections to determining whether the agency is being underpaid or overpaid, recording receivable or liabilities as appropriate.  Responsible for maintaining the accuracy and reporting of third-party balance sheet accounts.
  7. Update branches on trends, developments, concepts and best practice to ensure compliance in the Medicaid and Medicare fields that affect reimbursement services.
  8. Implements controls to ensure billing operations, medical coding, and insurance authorization departments are compliant with all regulatory guidelines, managed care contracts and agency policies and procedures.
  9. Ensure timely billing and best in practice for managing DSO.
  10. Implements key performance indicators (KPIs) for the billing, medical coding and insurance authorization departments in order to monitor and measure effectiveness. Provides coaching and guidance to departmental leaders on areas needing improvement.
  11. Coordinate exchange of information with branch locations and other departments to obtain and analyze additional patient information to document and process billing, respond to insurance inquiries, and manage liability accounts.
  12. Ensure timely and accurate administration of work processes within the system including the submission of electronic claims to third party carriers, claims logic development and maintenance, custom reporting and electronic remittance of third party payments.
  13. Prepares on-going analyses of all third party carriers and receivables to maximize agency’s cash flow.
  14. Maintains a detailed knowledge of all payment methods and associated governmental regulations, monitoring and analyzing changes.  Analyzes potential reimbursement issues or problems and makes recommendations for corrective actions.
  15. Coordinates Medicare, Medicaid, and other third-party payor audits.  Represents the organization in resolving reimbursement issues via audit resolutions, re-openings or appeals.  Researches issues, gathers and verifies accuracy of documentation, or prepares analytical and/or substantive documentation in support of agency’s position regarding such matters or compliance issues.  Responds timely and accurately to Intermediary, regulatory authorities, and other third party payors to obtain prompt resolution to issues.
  16. Maintains current knowledge of, and complies with established policies and procedures including patient confidentiality/patient rights, government, insurance and third party payor regulations.
  17. Maintains effective communications with all branch locations and other departments.


BENEFITS:

Competitive compensation and benefits. We offer a comprehensive benefit package which includes medical, dental, flexible spending account, life insurance, short term disability insurance, 401(k), PTO program, paid holidays, company paid parking, tuition assistance program, and much more!