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Reimbursement & MPV Control Manager

Reimbursement & MPV Control Manager

Requisition ID 
2018-5768
# of Openings 
1
Address 
100 Front Street
Job Locations 
US-MA-Worcester
Posted Date 
8/16/2018
Category 
Management
Department 
REV OPS BUSINESS OFFICE
Job Code 
MM111

More information about this job

Overview

Glob Top Places to WOrk 17

 

Reliant Medical Group is seeking a Reimbursement & MPV Control Manager  to join our exciting and innovative organization!

 

Full Time: 40 hours per week

Hours: 8:00AM - 4:30PM or 8:30am-5:00pm Monday-Friday

No nights or weekends

 

Responsible for all aspects of claim submission/programming, insurance collections/Accounts Receivable and resolution of insurance undistributed and credit balances. Manages the daily activities and processes of assigned staff and the training, development and streamlining of policies, procedures and workflow, staff productivity, quality of work and related duties.

Responsibilities

Manages the refunding, when appropriate, of insurance overpayments. Verifies that payments and refunds are in accordance with governmental rules/regulations, RMG policy/procedure and any applicable contracts and agreements.

 

Manages the disposition of insurance Credit and Undistributed payments. Strives to meet Revenue Operations metrics for acceptable Credit/Undistributed levels.

 

Assures that claims and insurance follow up functions are performed accurately, efficiently and timely in accordance with regulations, department goals and carrier contracts as well as Corporate month end/year end requirements.

 

Manages and maintains an efficient work process with an emphasis on automation and maximizing Epic Resolute Billing, EpicCare electronic health record utilization and claim scrubber software.

 

Manages lag time from date of service to claim submission for all points of service.

Measures and ensures staff productivity and accuracy within standards established.

 

Expands and improves on claim, insurance follow up and MPV variance reporting training and education sessions for assigned staff.

 

Manages third party receivable follow-up, ensuring that accounts receivable days are minimized and revenues are maximized. Works collaboratively with payers to resolve outstanding A/R and improve processes.  Ensures timely accurate appeals and resolution of insurance and coding-related denials received from Insurance or governmental carriers.

 

Works collaboratively with Coding Manager and Coding Follow Up Staff as their work is also related to insurance follow up initiatives.

 

Maintains MPV variance reporting and ensures accuracy of payments based upon payer contracts.

 

Verifies claims and remittance file loads/submissions and strives to improve submission errors and maintain established Revenue Operations performance metrics.

 

 

Keeps abreast of payer and industry guidelines and changes. Communicates changes with all appropriate Rev Op’s and Clinical Operations staff.

 

Works closely with physicians, internal and external managers, administrators, team leaders and others to ensure that billing is optimized and is performed with-in regulatory guidelines.

 

Creates and maintains efficient work processes with emphasis on automation and maximizing the use of the Billing System. Tracks/Trends reasons for denials/credits/undistributed and implements change to reduce volumes.

 

Measures and ensures optimal staff productivity and accuracy. Resolves discrepancies as required or directed.

 

Monitors assigned staff work-queue volumes to ensure productivity and quality of work and to identify areas requiring re-allocation of resources.

 

Reports and analyzes payment and receivable data to ensure Revenue Operations established Metrics are achieved.

 

Meets with Clinical Operations, Managers, Team Leaders, Information Technology or others to ensure integration of revenue cycle activities.

 

Collaborates with payors and with internal/external parties to resolve issues at a global level and expedite maximum reimbursement.

 

Collaborates with contracting to ensure accuracy and optimization of reimbursement and communication of contractual issues.

 

Qualifications

  • Bachelor’s Degree in Business Administration, Healthcare or related field.
  • A minimum of Three (3) years experience in a multi-specialty physician group practice, with a minimum of two years in a managerial capacity. 
  • Demonstrated experience in physician billing, reporting and revenue cycle including utilization of practice management systems.
  • Thorough knowledge of Medicare and Massachusetts third party payer requirements. 
  • Demonstrated experience in a health care professional billing environment. 
  • Strong competency level in regard to the use of professional billing software.
  • Demonstrated knowledge of insurance rules and regulations, claims submission, electronic remittance processes required.
  • Excellent interpersonal, organizational, and communication skills.
  • Epic Resolute proficiency required or obtained within 12 months of start date.

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