Director of Federal & MCO Revenue Cycle Management

Job Location:

Administrative Office - Lanham, MD, Position Type:
Full Time - 40 Plus Benefits, Education Level: Bachelor's Degree Obtained, Salary Range: $110000.00 - $120000.00

Salary/year, Travel Percentage:
Negotiable, Job Shift: Day, Job Category:
Finance and Accounting

The Director of Federal & MCO Revenue Cycle Management reports to the VP Finance and is responsible for managing the entire revenue cycle; not limited to, eligibility, authorizations, contracting and credentialing, clams billing, collections, rejections and denials management, monthly and yearly fiscal reporting and reconciliations, and assisting compliance reporting and audits. In addition, the Director is responsible for informing and training appropriate staff on any new billing procedures, and will attend outside trainings and meetings.

He/She will work closely with the Regional Vice Presidents and Finance to ensure that the programs are complaint with payer regulations, and the revenue cycle is maximized.

• Supervises a team of medical billers, authorization staff and credentialing staff to ensure all credentialing, authorizations and billing and collection process are current and up to date.
• Oversees and ensures the electronic EHR is configured and operating per payer regulations
• Ensure insurance is verified and accurate in the EHR. Use the 270/271 eligibility files at the beginning of the month
• Works with program staff to ensure current Consumer’s information and status is entered in the EHR accurately and maintained for collection, services offered, and BHSD reporting.
• Works with program staff to ensure that authorizations are current, and request supplemental units as needed.
• Ensures pre-billing reports are cleared before billing for the week. These reports must be zeroed out by month and year end.
• Supervises the process of extracting, posting, reviewing, and transmitting complete Medicaid billing for all programs.
• Reconciles and confirms all billing reports received with the services performed and claims transmitted. Addresses any problems with rejected 837p files and resubmits files once corrected.
• Identifies and analyzes problems and implements solutions as needed or instructed.
• Ensures all payments are posted within the month the payment is received, all denials must be worked in the month received. Approved any write off’s or adjustments.
• Performs a hard close in EHR. Provides program leadership and accounting staff with financial reports for revenue recognition, AR reconciliations, adjustments, and payments received by the 10th of the month.
• Assist in audits; including but not limited to, yearly financial audit, and payer claims audits.
• Works with Compliance team to enforce internal and payer regulations.
• Works with Program staff to ensure that Providers are compliant with licensure and credentialing requirements to successfully bill for services rendered.
• Monitors the accounts receivable to ensure that billing, appeals and claim corrections are filed and completed within federal and MCO time limits to resolve all outstanding claims. .
• Maintains open communications with all related staff to facilitate and resolve billing issues and problems any denied claims. Initiate meetings with staff as needed.
• Develops and maintains open communications and positive relationships with community resources and agencies as needed to effect and enhance the billing process.
• Maintains current knowledge of the billing process and state and local billing procedures.
• Maintains working knowledge of the VOACC Policies and Procedures and program procedures as related to operations, services, and billing.
• Responsible for keeping required records of service-related items in conjunction with finance.
• Attends…