Director of Reimbursement

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GULF COAST CENTER - JOB DESCRIPTION

Job Title: Director of Reimbursement

Location: Galveston County

FLSA Status: Exempt

Working Status: Full-time with benefits

Summary:

Directs and oversees the overall policies, objectives, and initiatives of the organization's revenue cycle activities. Reviews, designs and implements processes surrounding pricing, billing, third party payer relationships, collections and other financial analyses to ensure that clinical revenue cycle is effective and properly utilized.

Reports to the Chief Financial Officer and is responsible for planning and leading the daily work flow of the activities for billing staff members, as well as ongoing department metrics, production and financial goals through effective management of resources. The Director has strong connection to the Program Management.

Gulf Coast Center operates under a trauma-informed approach based on the six key principles of Safety, Trustworthiness & Transparency, Peer Support, Collaboration & Mutuality, Empowerment & Choice, and Cultural, Historical & Gender issues.

Job Duties: (To be performed with or without accommodation as based on ADA requirements)

The Director or Reimbursement will be responsible for the following:

Essential Job Duties:

  • Develops, organizes and implements overall billing, collection and payment reimbursement functions.
  • Champions revenue cycle improvements throughout the Center, working with both financial and program staff to maximize efficiencies and effectiveness of the revenue cycle, including aiding in the resolution of identified issues impeding revenue collection.
  • Plans, directs, reviews, coordinates and evaluates through the functions of the department to increase positive cash flow, achieve operational efficiencies, and ensure compliance with established laws, regulations, practices and procedures.
  • Monitors accounts sent for collection and reimbursements from insurance companies and other third party payers. Performs ongoing trend analysis on claims rejection, claims denial and claims suspense. Works closely with appropriate staff to resolve systematic issues related to third party reimbursement.
  • Prepares financial analysis for utilization in the third party and manage care negotiation process through collaboration with the Center's contract division.
  • Ensures education training and development of members of the Billing/Collection Payment Post/Client Benefit Team.
  • Monitors and collaborates with the Chief Financial Officer regarding the value and collect ability of accounts receivable, including making recommendations to maintain an acceptable ?days of revenue in A/R?. 
  • Attends, participates and provides constructive input as a member of the Center's senior level management team, including the ability to report activities related to revenue enhancement efforts.
  • Develops, organizes, implements and maintains overall front office desk procedures.
  • Develops, organizes, implements and maintains overall Client Eligibility Assistance to include screening and assisting clients that may be eligible for benefits such as Medicaid and SSI etc.
  • Attends, participates and provides constructive input as a member of the Center's senior level management team, including the ability to report activities related to revenue enhancement efforts.
  • Responsible for attending Reimbursement Coordinator's Consortium Meetings
  • Responsible for maintaining event and billing  rules in current system's operating software
  • Oversight of provider enrollment applications for all Insurance plans.
  • Responsible for developing procedure for and training staff on Pre-Authorization.
  • Will be responsible and accountable for the adherence to and promotion of the agency compliance policy and will require communication with various departments to foster, develop and continue our community partnerships as it relates to the position.
  • Treat all individuals with the utmost courtesy, decency and respect.
  • Provide responsive, and efficient services.
  • Interact with staff, consumers, local entities and advocacy groups to provide a service that meets local needs.
  • Provide highest level of Customer Service for both internal and external customers.
  • Required to report personnel leave; flex time and emergency leave to assigned supervisor.
  • Strict adherence to the professional, ethical, and legal requirements set forth in GCC's Business Code of Conduct as well as the Corporate Compliance Plan.
  • Consistent adherence to the Center's Dress Code.
  • Consistent adherence to Center safety guidelines and expectations.
  • May be required to travel within Brazoria and Galveston Counties.
  • Out of region travel may be required to attend trainings.
  • Must maintain a clear driving record and driver's license in accordance with our Driver Policy.
  • Requires current Texas Driver's License, reliable transportation and must maintain current auto liability insurance.

Non-Essential Job Duties:

  • Prepare monthly revenue cycle reports to Executive Management Team.
  • Responsible for training clinical staff on Direct Service Tracking for multiple cost reporting measures.
  • Responsible for assisting IT department as needed for billing issues related to current system's operating software.
  • Assist in the measurement of the allowance of doubtful accounts.

Supervision:

Receives direct supervision from Chief Financial Officer.

Required Education:

Bachelors degree in a business or hospital administration related field.

Preferred Education:

See "required".

Required Experience:

  • 5 years staff supervision
  • 5 years experience in revenue cycle management or third-party reimbursement for a health system, hospital or community based healthcare provider organization.
  • Knowledge of insurance practices, specifically Medicaid and Medicare.
  • Proficiency in National Standards related to CPT and ICD coding.
  • Demonstrated ability in developing new workflows.
  • Proven experience in using analytical tools and applications.

Preferred Experience:

  • 10 years experience in staff supervision
  • 10 years experience in revenue cycle management or third-party reimbursement for a health system, hospital or community-based health care provider organization.
  • Experience with the State of Texas billing practices
  • Experience with creating desk procedures and implementation of those procedures
  • Experience with current EHR
  • Experience and knowledge of customer service, scheduling and switchboard operations.
  • Experience with insurance authorizations

Certificates Required:

N/A

Abilities/Traits:

  • Excellent organizational skills
  • Self-Motivated
  • Able to work with little of no supervision
  • Interpersonal skills necessary to function as a member of work team and to correspond with external agencies.
  • Excellent time management, multi-tasking, critical thinking and accuracy skills.
  • Ability to express self clearly and effectively, orally and in writing.
  • Requires ability to work within a team approach.
  • Requires proficiency with computer skills, programs and email.

Working Conditions:

  • Work will be performed in the Office, Field and/or Remotely setting(s).
  • May require varied work hours depending on need of clients.
  • Out of region travel may be required to attend trainings.
  • May require travel to various locations within Brazoria and Galveston Counties. Requires current Texas Driver's License, reliable transportation safe and current with all state requirements, and liability insurance.

Special Projects:

  • Assist supervisor when requested to complete special projects and complete all assignments within a time frame negotiated with the supervisor. Completion of other duties as assigned by supervisor as it relates to the program and position.

Job Related Physical/Mental Requirements & Environmental Conditions:

Physical:

  • Ability to transport, adjust and/or move items up to 45 lbs.
  • Ability to ascend/descend stairs.
  • Ability to remain in a stationary position for long periods of time.
  • Ability to handle objects.
  • Ability to operate office equipment.
  • Ability to move around within an office setting and/or other locations as needed; may include ability to bend/twist, kneel/stoop and/or reach for items.
  • Ability to detect and write effectively.
  • Ability to hear (with or without aid).
  • Ability to have visual acuity to operate a motor vehicle and observe objects within work setting.

Mental:

  • Ability to accept constructive criticism.
  • Ability to maintain regular attendance.
  • Ability to understand, communicate and comprehend accurate information with others in English.
  • Ability to reason and analyze effectively.
  • Ability to solve practical problems as it relates to position.
  • Required to pass and maintain all Center mandated trainings.

Work Site/Environmental Conditions:

  • Ability to work alone.
  • Ability to work closely with others.
  • Ability to work long and/or irregular hours.
  • May be subjected to hostile environment.
  • May be subjected to both inside and outside environmental conditions.
  • Subject to standard noise levels within working environment.
  • Travel by motor vehicle, van, bus or plane may be required.

Qualified individuals must be able to perform these functions with or without reasonable accommodations as based on ADA requirements.