Reimbursement Manager
S2 - BioScrip - Norfolk, VA

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GENERAL PURPOSE :
This position manages the billing, third party insurance collections, and cash posting activities for multiple teams responsible for reimbursement operations and accounts receivable (A/R) for HomeChoice pharmacies in accordance with company policies and in compliance with federal, state, and SOX regulations.

This position has full supervisory responsibility for recruitment, hiring, retention, performance development, performance management, teammate relations, salary adjustments, and termination of direct reports.

ESSENTIAL DUTIES AND RESPONSIBILITIES :
The following duties and responsibilities generally reflect the expectations of this position but are not intended to be all inclusive.
  • Manage work of teammates and participate as necessary to ensure goals are met within established policies and procedures
  • Manage the Third-Party Billing and Collections team to minimize Third-Party A/R
  • Ensure appropriate controls and procedures are in place to guarantee timely and accurate billing and collections practices
  • Manage the Cash Posting team to ensure all Third-Party (Insurance) and Patient payments are applied in accordance with company policies
    • Complete weekly reconciliation of payments received and posted to meet Cash Controls and SOX compliance requirements
    • Ensure patient billing statements are produced accurately and mailed timely each month
  • Manage the Medicare Part B Billing team to ensure billing and collecting on Medicare Part B items (as well as resulting secondary billable items) are completed timely, accurately, and in compliance with all laws and regulations
  • Participate in achieving pharmacy-wide goals including but not limited to Patient Retention and Quality initiatives
  • Review daily, weekly, and monthly key metrics to identify trends or areas of focus; inform Director of variances and trends
Maintain confidentiality of all patient, teammate, and company information in accordance with HIPAA regulations and DaVita policies
  • Collaborate closely and in conjunction with Director with other HomeChoice departments and teammates as well as with DaVita facility teammates as necessary for the overall benefit of patients and achievement of mutual goals
  • Maintain current knowledge of all laws, regulations, and changes that may impact the Reimbursement Operations team
  • Travel Required: up to 10%
Teammate Management
  • Provide leadership to direct reports
    • Help direct reports overcome any organizational obstacles encountered during projects
  • Manage all teammate employment activity such as hiring, promoting, job performance, evaluations, retention, and disciplinary actions with appropriate approvals as required
  • Address teammate relations issues appropriately and escalate as necessary
  • Develop, document and implement action plans, as appropriate, to address deficiencies identified while reviewing teammates work product
    • Know, understand, implement, follow, and communicate to teammates all DaVita employment policies and procedures, awards, and other opportunities within company and foster a positive work environment
      • Ensure all HomeChoice employment processes are completed timely and in compliance with DaVita policy and any applicable laws including but not limited to ePCNs, Performance Development Reviews, teammate personnel file maintained, etc.
    • Facilitate teammate development (PDRs, coaching, mentoring, DaVita training, outside training); collaborate with direct reports to create professional development goals
    • Provide consistent, visible, and timely communication to team on team goals, objectives, progress toward goals and enable teammates to meet job responsibilities successfully
    • Maintain familiarity with and communicate to teammates DaVita programs impacting teammates (including but not limited to: Triple Crown, We Are Here, Tuition Reimbursement, Foundations, etc.)
    • Ensure new teammates receive the appropriate training, tools, system access, and support to effectively complete their duties, understand department, computer systems, their role, and company policies, procedures and compliance standards
  • Provide work direction for department teammates
    • Determine staffing plans that promote the most effective use of all teammates; provide adequate staffing levels and phone coverage for all hours of operations; ensure coverage during teammate absences
  • Know and understand basic wage and hour laws, federal, state and local laws and regulations, Medicare, and legislation affecting employment
    • Review and approve time cards of hourly direct reports for bi-weekly payroll
    • Track overtime, attendance, and PTO
  • Develop and conduct educational programs to keep teammates up-to-date on DaVita policies, new laws and regulations impacting work, and other information necessary to maintain teammates knowledge of department processes and goals
  • Know, understand, follow, and implement DaVita safety and security policies and procedures

ESSENTIAL BEHAVIORS, SKILLS, AND ATTITUDES REQUIRED FOR SUCCESS IN THIS POSITION
  • Commitment to and role model of HomeChoice/DaVitas values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun with ability to demonstrate those positively and proactively to patients, teammates, management, physicians, and/or vendors (Village Service Partners) in everyday performance and interactions
  • Ability to manage multiple projects, deadlines, and priorities in a fast-paced, ever-changing and evolving work environment
  • Demonstrated ability to work effectively at both detail and big-picture levels
    • Demonstrated strengths in organizational, attention-to-detail, follow-through, reasoning, critical thinking, and problem-solving skills
    • Strong analytical skills with the ability to seek out underlying assumptions through probing, questioning, and listening
    • Ability to proactively identify and analyze issues and to identify and implement solutions collaboratively
  • Analytical thinker with demonstrated ability to perform root cause analysis, prepare and implement action plans, and lead improvement initiatives
  • Strong customer service skills and commitment to service excellence
  • Demonstrated ability to think outside-the-box
  • Proven leadership skills and the ability to collaborate across functions
    • Strong understanding of business process; ability to maximize resources to accomplish key metrics
    • Demonstrated ability to create, refine, and manage new business processes
  • Strong written, verbal, and interpersonal communications skills including ability to listen attentively and to communicate information clearly and effectively
    • Demonstrated ability to work well with cross-functional groups
    • Demonstrated interpersonal, collaborative, and relationship-building skills; ability to interact positively with teammates at all levels of the company
    • Approachable and open
    • Demonstrated ability to communicate difficult or sensitive information tactfully
  • Professional presence and strong presentation skills
  • Willingness and ability to create a team learning environment and to foster a positive, fulfilling work environment
  • Willingness to assist teammates in order to achieve departmental goals
  • Demonstrated strengths in teambuilding and leadership skills
  • Supervisory experience demonstrating willingness, desire, and ability to supervise with aptitude and skills for coaching, mentoring, training, and developing teammate performance
  • Demonstrated ability to balance department efficiency and field service excellence
  • Willingness to assist teammates in order to achieve departmental goals
  • Demonstrated strengths in teambuilding and leadership skills
  • Willingness and desire to create a team learning environment and to foster a positive, fulfilling work environment

  • S2 - BioScrip - 17 months ago - save job - block
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