Director of Federal, MCO Revenue Cycle Management

This is a fully remote position, open to applicants in Maryland.

📋 Description

• Oversee the complete revenue cycle, which encompasses eligibility, authorizations, contracting and credentialing, claims billing, collections, management of rejections and denials, fiscal reporting, and reconciliations.

• Report directly to the VP of Finance.

• Supervise a team of medical billers, authorization personnel, and credentialing staff.

• Ensure that EHR configuration and operation align with payer regulations.

• Verify insurance details and maintain accurate consumer information within the EHR.

• Utilize 270/271 eligibility files at the start of each month.

• Confirm that authorizations are up-to-date and request additional units as necessary.

• Clear pre-billing reports prior to weekly billing and month/year-end closing.

• Oversee the extraction, posting, review, and transmission of Medicaid billing.

• Reconcile billing reports with services rendered and claims submitted.

• Address rejected 837p files and resubmit corrected versions.

• Post payments in the month they are received and handle denials within the same month.

• Approve write-offs and adjustments while performing hard closes in the EHR.

• Deliver financial reports for revenue recognition, accounts receivable reconciliations, adjustments, and payments by the 10th of each month.

• Assist with annual financial audits and payer claims audits.

• Collaborate with the Compliance team to uphold internal and payer regulations.

• Ensure that providers meet the necessary licensure and credentialing standards for billing.

• Monitor accounts receivable, appeals, and claim corrections within federal and MCO timelines.

• Engage with staff to resolve billing issues and denied claims; initiate meetings as required.

• Foster relationships with community resources and agencies.

• Maintain an up-to-date understanding of billing processes and state/local billing regulations.

• Stay informed about VOACC and program policies and procedures.

• Keep necessary service-related records in coordination with Finance.

• Attend staff and organizational meetings while performing other designated tasks.

• Travel to assigned locations and operate office equipment as necessary.

⛳️ Requirements

• Bachelor's Degree in Healthcare Administration or a related discipline.

• At least five years of experience working with Medicaid payments, private insurance, or within the revenue cycle.

• A minimum of three years of experience in staff management and goal setting/development.

• Specialized training in Medicaid or healthcare billing processes and revenue cycle management.

• Ability to establish parameters for claim accuracy, rectify trend errors, and provide solutions for timely claim processing.

• Experience in coordinating workflow, supervising, and training both new and existing staff while managing changes related to payment processing and procedures.

• Background in appeals and resolving billing coding errors for reimbursement.

• Proven experience in team management, goal setting, and the use of benchmarks and KPI matrices.

• Ability to research, prepare, maintain, and review reports and documentation in an accurate and timely manner.

• Strong problem-solving and execution capabilities.

• Cultural sensitivity and the ability to work effectively with individuals from diverse backgrounds.

• Exceptional written and verbal communication skills.

• Proficiency in Microsoft Office: Word, PowerPoint, Excel, and Outlook.

• Experience with Credible Software, Practice Management Systems, and third-party clearinghouses.

• Capability to understand various technology systems and general office resources.

• Valid driver's license and ability to travel to assigned locations.

• Preferred: Master's degree.

• Preferred certification as CPC, CPB, or CCS.

• Bilingual in any language is a plus.

🏝️ Benefits

• Plus benefits