Director of Federal & MCO Revenue Cycle Management

The Sr. Director of Federal & MCO Revenue Cycle Management reports to the Vice President of Finance and is responsible for managing the entire revenue cycle, including but not limited to, eligibility, authorizations, contracting and credentialing, claims billing, collections, rejections and denials management, monthly and yearly fiscal reporting and reconciliations, and assisting with 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.

They will work closely with the Regional Vice Presidents and Finance to ensure programs comply with payer regulations and maximize revenue cycle performance.

The Sr. Director of Federal & MCO Revenue Cycle Management reports to the Vice President of Finance and is responsible for managing the entire revenue cycle, including but not limited to, eligibility, authorizations, contracting and credentialing, claims billing, collections, rejections and denials management, monthly and yearly fiscal reporting and reconciliations, and assisting with 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.

They will work closely with the Regional Vice Presidents and Finance to ensure programs comply with payer regulations and maximize revenue cycle performance.

• Supervises a team of medical billers, authorization staff and credentialing staff to ensure all credentialing, authorizations and billing and collection processes are current and up to date.
• Oversees and ensures the Electronic Health Record (EHR) is configured and operating per payer regulations
• Ensures 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 information and status are 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 requests 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. Approves any write-offs 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.
• Assists in audits, including but not limited to yearly financial audits and payer claims audits.
• Works with the 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 and any denied claims. Initiates…