Payment Resolution Director - Payer Specialization
Duties (included but not limited to):
- Oversee the activities and management related to Payment Compliance discrepancy inventory, ensuring processes are performed efficiently, effectively and accurately.
- Establish controls and review mechanisms for SSC policies and procedures.
- Ensure timely submission of reconsiderations, payer packages and liquidation of discrepancy inventory.
- Monitor, trend and communicate with SSC, facility and corporate leadership, regarding trends, new inventory fluctuations and outstanding inventory identified via EDW, Vista, and other denials tools reports.
- Demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner.
- Understand and communicate contract specific issues related to the resolution of disputed payments, discount and allowance calculations for a variety of payers such as Medicare, Medicaid, HMOs, PPOs, IPAs, employers, etc.
- Oversee management of personnel, providing recommendations for hiring, promotion, salary adjustment and personnel action where appropriate.
- Follow escalation protocols to include Attorney, Corporate Dispute Resolution and Corporate Payment Compliance.
- Participate in Joint Operating Committees (JOC) with payers, ensuring partnership in inventory resolution.
- Oversee all reconciliation activities for inventory.
- Proactively ensure training of all employees, including identification and communication of any operational gaps identified in day to day activities.
- Identify and implement process improvements to lower billing costs and improve services to facility customers.
- Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”.
- Other duties as assigned.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
KNOWLEDGE, SKILLS & ABILITIES
- Technical Expertise – Some understanding of healthcare including knowledge of healthcare terms and accounts receivable processes
- Strategic Analysis - Analytical Review skills and ability to make decisions based on analysis
- Leadership - guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services
- Tactical execution - oversees the development, deployment and direction of complex programs and processes
- Financial management - applies tools and processes to successfully manage to budget
- Project Management - assesses work activities and allocates resources appropriately
- Organization - proactively prioritizes needs and effectively manages resources
- Communication - communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately. The ability to communicate with staff, Parallon Management, Division and Group Executives
- Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
- Interpersonal skills - able to work effectively with other employees, patients and external parties
- PC skills - demonstrates proficiency in Microsoft Office applications and others as required
- Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
- Basic Skills – demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes, have ability to work quickly and accurately in a fast-paced environment while managing multiple demands, ability to work both independently and collaboratively as a team player, adaptability, analytical and problem solving ability and attention to detail and able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly. Spell correctly and transcribe accurately.
- Bachelor’s Degree in Business or related field required. If a desired applicant does not have a Bachelor's Degree, the requirement can be waived IF they are currently in a BachelorDegree program.
- Minimum 7 years' healthcare management experience with three of these years in the related area for the position. Relevant education may substitute experience requirement with SSC Executive approval.