Under the supervision of the Chief Financial Officer, the Reimbursement Manager is responsible for billing, fee collections, and analysis of all clinical services billed to self-pay, Medicare, Medicaid, Managed Care Organizations (MCO), commercial insurances, state restricted payor sources and other local agencies. In addition, this position is responsible for the formal supervision and training of accounts receivable staff and day-to-day guidance of other support staff around reimbursement. Furthermore, the Reimbursement Manager is responsible for the coordination, implementation, and maintenance of clinical services and payor code rules in the electronic healthcare record (EHR) system. This position is also responsible for coordinating and collaborating with Director of Programs, Compliance, and Information Technology Department to assure a system of accuracy and compliance with Federal and State regulations and payor requirements to maximize revenue collection.
This job description is based upon an evaluation of agency requirements at the time this description was written. This job description will change as the position is developed further, or in response to organizational or technological changes.
MAJOR DUTIES AND RESPONSIBILITIES:
Department Management
- Directs all billing functions and fees collections for services related to Reimbursement of clinical services from all payor sources: Virginia Medicaid, Department of Medical Assistance Services (DMAS) Managed Care Organizations (MCOs), various Commercial Insurance payors, State and Local Agencies and self-pay.
- Monitors EHR pre-billing reports to ensure timely billing of agency services and completes monthly closing processes.
- Supervises the Accounts Receivable/Reimbursement staff.
- Serve as Agency’s Billing/Reimbursement liaison to insurance carriers, DMAS, Virginia Association of Reimbursement Officers (VARO), Virginia Association of Community Services Board (VACSB) roundtable, Medicare, each MCO, and other necessary payors and related organizations as needed, attending regular meetings and workshops/trainings by the payors and related organizations and inform representatives of necessary information.
- Provides guidance and training to staff and programs on reimbursement policies and procedures, making recommendations to assure agency’s policies and procedures are modified as needed for compliance and to support the maximization of agency revenue.
- Maintains billing contracts/agreements with all payor sources and oversees all payor sources’ policy and procedures manuals are reviewed and changes are communicated as needed to program managers and the direct care staff.
- Oversees the Bankruptcy process and serves as liaison to receive Bankruptcy notifications for the agency. Enters and manages the accounts in bankruptcy either through filings or discharges.
- Maintains Agency Reimbursement Policy and Procedure Manual and communicates changes to the Chief Financial Officer and Agency staff for training and updates.
- Coordinates with the Information Technology Department to initiate, audit, and maintain user billing permissions and access levels within the electronic health record software.
- Monitors and analyzes electronic fee revenue data/reports and informs CFO of incoming fee revenue amounts and any potential concerns or delays that could impact agency cash flow.
Billing Management and System Maintenance
- Responsible for maintaining billing rules in the EHR for all payors to include payors, payor code rules, and fees/rates to ensure services bill accurately and in accordance with regulatory standard and requirements, reviewing all guidance regarding policy and procedures for payor sources to ensure billing rules are updated as necessary.
- Responsible for the maintenance of the electronic billing form layouts for all payors dictated by the payors and Federal and State regulations, communicating with the EHR liaison as needed.
- Maintains service and billing matrix lines in the EHR to ensure accurate processing of program services fees per state guidelines and regulations.
- Maintains and updates all EHR staff billing information for insurance and third-party payors.
- Coordinates the resolution of claim adjudications, denials, and rejections with payors and communicates with divisions on denials and adjustments made to correct future billings, auditing payments and reports and serving as a liaison with third party payers and supervises resolution of all claim issues in a timely manner.
- Coordinates all adjustments, Board write-offs, and accounts submitted from Reimbursements for Debt Set-Off with Chief Financial Officer, serving as the Primary Coordinator.
Reporting/Compliance
- Maintains and collects statistics/data to generate accounts receivable and fee reports for the program management staff and other users serving as the billing liaison for clinical quality review.
- Participates in compliance and information technology audits, reviewing and returning money back to payors through claims adjustments or processing requests to issue a check through the accounts payable system.
- Assists and reports information for all audits of agency reimbursement system and accounts receivable.
- Reviewing deposit transaction report from the online banking system and payor electronic deposits to record payments into the electronic healthcare record system and client accounts.
- Maintains and analyzes the Agency’s fee schedules and ability-to-pay scales, communicating recommendations regarding changes to the CFO.
Miscellaneous
- Performs other duties as assigned, which are consistent with the position and in compliance with the agency’s policies and procedures
QUALIFICATIONS:
- Bachelor’s degree in business administration, Healthcare Data Management, Health Information Technology, or related field required. In lieu of degree, five years of relevant experience may suffice.
- Five years of experience in automated accounting, billing, and collections environment in a healthcare setting, with at least the last two years of experience in a leadership or training role required; billing experience related to Medicare, Medicaid, Third-Party insurance, or other payor source(s) required.
- Experience in web-based billing applications and software required.
- Progressively responsible work experience required; supervisory experience preferred.
- Work experience in behavioral health care field related to mental health, intellectual disability and substance use preferred.
- Must possess a valid Driver’s License, an acceptable driving record, and the ability to provide your own transportation.
ADDITIONAL REQUIREMENTS:
- May be exposed to allergenic environments from client’s homes, including dust, smoke, pet contamination, cleaning supplies, etc.
- May be exposed to clients with infectious diseases.
- Must be able to walk distances, climb and descend stairs, maneuver in and out of agency vehicles.
- Prolonged periods sitting at a desk and working on a computer.
- Must be able to lift/push/pull up to 25 pounds at times.
SALARY: $70,903 – $87,156
POSITION: ID062
RETIREMENT: NWCSB participates in Virginia Retirement System.
DISCLAIMER: All full-time employees are eligible for a complete benefits package that includes enrollment in Virginia Retirement System. For more information about benefits and a complete list of current job openings, please visit our website, www.nwcsb.com. Positions remain open and advertised until filled.
If you need assistance or an accommodation to apply or interview, contact Human Resources at [email protected] or 540-636-4250, Ext 2155.
Northwestern Community Services Board provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.