Manager, Payor Policy & IQA

This employee manages multiple teams critical to the billing quality for all DME and Oxygen equipment, drugs, supplies, and services.

• Oversees payor contract updates in the EMR, ensures government payor updates are communicated and implemented in a timely and effective manner, oversees special projects related to billing quality, manages internal billing quality assurance reviews, ensures that projects and assigned tasks are completed timely with accuracy and in accordance with the CIA structure, as well as following all payor and state guidelines.
• Acts as SME for all payor policy‑related topics as needed.
• Works closely with Chief Compliance Officer on special projects as needed.

• Serves as the company‑wide liaison for payor issues, works with Operations, billing offices, and payors to assist in resolving payor issues/concerns that arise.
• Oversees the Vent Queue Team.
• Oversees the contract review team to ensure that payor contracts are being reviewed timely and accurately in accordance to the guidelines set in place.
• Oversees company‑wide assigned projects and assignments.
• Works with applicable departments to ensure that changes in policies are being addressed timely.
• Monitors and maintains all payor relationships ensuring all state, federal, and local government billing requirements are met while working through the assigned projects.
• Assists with writing and developing of policies and procedures.
• Liaison for any CIA and internal audits.
• Manages internal monthly and ad hoc billing quality reviews, overseeing the review process, data collection, delivering results, and education.
• Assists in identifying areas that need to be reworked or addressed.
• Resolves employee issues as they apply.
• Delivers directives from the Corporate office as they apply.
• Communicates with Executives, Legal, Compliance, and any applicable parties pertaining to the centralized billing departments.

• Associate's Degree or equivalent from two‑year college or technical school, Preferred.

• 2-3 years, Required.

• Read, analyze, and interpret general business periodicals, professional journals, technical procedures or correspondence, payor contracts, fee schedules and policies, state and federal healthcare billing guidelines, and procedure manuals.
• Effectively present information and respond to questions from groups of managers, clients, vendors, Executives, and other stakeholders.
• Work with and apply mathematical concepts such as probability and statistical inference, and fundamentals of concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Define problems, collect data, establish facts, and draw valid conclusions.