Director of Reimbursement Westchester IL

PURPOSE AND SCOPE:

Supports FMCNA’s mission, vision, core values and customer service philosophy. Adhere to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.

Provides direction and oversight for all activities related to the accounts receivables function for an assigned geography and the pertinent FMS billing group(s). These activities include: ensuring accurate posting of revenue, timely billing, cash collections, timely recognition of bad debts, the integrity of data and proper use of automated systems, resolution of unreconciled payments, and reconciliations of all AR GL accounts. Ensures that all billing and collections are completed in a timely manner and in accordance with company policies and procedures and regulatory requirements.

DUTIES / ACTIVITIES:

CUSTOMER SERVICE:

• Responsible for driving the FMS culture through values and customer service standards.
  
• Accountable for outstanding customer service to all external and internal customers.
  
• Develops and maintains effective relationships through effective and timely communication.
  
• Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.

PRINCIPAL RESPONSIBILITIES AND DUTIES

• Ensures proper and effective management of receivables at a Billing Group level maintaining positive cash flow, maximizing reimbursement, and reducing bad debt whilst ensuring compliance with all pertinent regulatory requirements and Corporate/Divisional policies and procedures.
  
• Oversees the functions of the Billing Group(s) of an assigned geography to ensure successful management of the receivables and effective and efficient function of the revenue cycle.
  
• Develops strategic plans and initiatives to improve operations and results and to maximize resources
  
• Ensures Billing and Collection personnel are appropriately trained according to FMCNA and Regulatory policies and procedures.
  
• Ensures that Billing Group(s) operates in accordance with established Corp/Division /Department policies and procedures.
  
• Reviews the operational processes in and where necessary, provide direction to correct deficiencies.
  
• Monitors the billing process to ensure timely and accurate submission of all claims in order to maximize revenue and minimize bad debts.
  
• Ensures billing group(s) take advantage of all available third party coverage options.
  
• Ensures that corporate policies and Medicare regulations are followed with respect to bad debt recognition.
  
• Ensures that proper financial controls are employed within the Billing Group(s) specifically regarding the recording and reconciliation of the cash receipts account, and ensuring proper and complete recognition of revenue in accordance with GAAP.
  
• Monitors bad debt reserves
  
• Monitors revenue, contractual adjustments and write-offs
  
• Ensures all new hire and promoted staff receives the pertinent training to ensure effective functioning in the new roles.
  
• Provides direction, oversight and support to Managers of Reimbursement and Billing Group Department staff providing guidance and subject matter expertise as needed to ensure the effective and efficient functioning of the Billing Group Accounts Receivable functions.
  
• Drives the performance of the employees by establishing expectations/goals at the beginning of the appraisal year, providing informal feedback throughout the year and formal feedback through the company annual performance review process.
  
• Manages the department staffing through the appropriate hiring, firing and disciplinary actions.
  
• Monitors issues pertaining to billing group operations and day to day activities of the accounts receivable function of the assigned geography.
  
• Ensures the appropriate actions are taken to address the identified issues resulting in an effective and suitable resolution.
  
• Addresses and corrects any audit and compliance issues identified.
  
• Ensures that cash receipts are reconciled monthly to the appropriate bank statements and that variances are resolved expeditiously.
  
• Ensures Corporate and Division management are informed regarding all major issues impacting billing group operations and collections.
  
• Addresses and resolves major third party payer issues
  
• Monitors AR trends closely taking prompt decisive action to remedy operational and collection problems.
  
• Conducts weekly and/or monthly AR meetings with Managers to review collections issues in order to ensure that proper follow-up activities and billing procedures have occurred.
  
• Ensures Billing Group(s) comply with established policies and procedures regarding the admission process and where necessary, works with the respective facility operations management staff to resolve issues, escalate as necessary.
  
• Monitors the level of performance for Billing Group(s) personnel working with the pertinent managers to develop the appropriate action plan to address any deviations from acceptable levels of performance.
  
• Establishes strong working relationships with all Medicare Administrative Contractors (MACs) / payers.
  
• Utilizes these contacts to resolve issues which impact payment of claims, such as pricing, pre-payment reviews or delays in payments, etc.
  
• Maintains current knowledge of Medicare and insurance regulations and ensures compliance by field financial operations entities.
  
• Prepares weekly and monthly reports for divisional mgmt as required.
  
• Examples of these reports would be quarterly bad debt reports, days outstanding analysis, monthly status reports, analysis of write-offs and adjustments.
  
• Become familiar with all available secondary insurance options.
  
• Collaborates with the Financial Coordinators / Social Workers to ensure that each patient is afforded the opportunity to subscribe to the plan that best meets patient and company needs.
  
• Other duties as assigned.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Day to day work includes desk and personal computer work and interaction with patients, facility staff, and physicians. The position requires travel between assigned facilities and various locations within the community. Travel to Division, and corporate meetings may be required.

EDUCATION:

Bachelors degree required, Finance or Business major preferred.

EXPERIENCE AND REQUIRED SKILLS:

• 5 to 10 years prior experience in healthcare finance, or reimbursement, including at least 2 years management experience
  
• Strong management and analytical skills
  
• Excellent written and verbal communication skills
  
• Good leadership and interpersonal skills – team building skills and ability to motivate
  
• Proficiency in Financial software applications and Microsoft Excel, Access, SAP Business Warehouse
  
• Good organizational skills with ability to prioritize/time management, detail oriented and flexible
  
• Prior knowledge of Billing Software
  
• Fundamental knowledge of general accounting cycle and an understanding of revenue cycle
  
• A good understanding of General Accounting Principles