Director of Federal, MCO Revenue Cycle Management
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Job Description
Revenue cycle director managing Medicaid, insurance billing, denials, audits, and EHR processes for VOACC’s behavioral-health programs. Supervising billing, authorization, and credentialing teams.
Responsibilities:
- 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
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