Description

Introduction

The Director of Reimbursement directs and coordinates activities of employees engaged in back-office revenue cycle management including data entry, claims filing, appeals/reconsiderations, payment posting and reconciliation, physician query processes, denial analysis, coding analysis, fee schedule analysis and maintenance, and insurance company reimbursement analysis.

The objective of this position is to increase collections through detailed analysis and process improvement working together with business office staff as well as other departments practice-wide.

This position is considered Work from Home; however, candidates must be in the Dallas- Fort Worth TX market to visit the office as needed for training and meetings.

Job Summary and Qualifications

• Lead and mentor a team of 13+ billing A/R specialists. Provide guidance, training, and support to ensure high performance and professional development.

• Develop and implement reimbursement strategies aligned with the organization's goals and objectives. This includes analyzing market trends, payer policies, and regulatory changes to identify opportunities for revenue optimization.

• Develop key performance indicators (KPIs) and metrics to monitor reimbursement performance. Analyze data to identify trends, issues, and opportunities for improvement.

• Function as liaison to MSO and communicate regularly with them working together to improve division days in A/R, collections, decreased denials and other dashboard indicators.

• Oversees the timely and accurate data entry of charges.

• Assesses self-pay policies and improves them as needed; implements reception audits and other processes to improve self-pay front end and back end collections.

• Assesses preauthorization policies and processes and change as needed to decrease denials.

• Analyze denials on a monthly basis and implement processes to decrease denials by focusing on top denial reasons.

• Analyze fee schedules and modify as needed to appropriate reimbursement.

• Analyze enrollment processes and work with enrollment department to improve timeliness of completed enrollment and to minimize claims to hold and enrollment related denials.

• Analyze insurance contract reimbursement and work with managed care department and local managed care contracting staff to improve reimbursement and contract language terms where possible. Includes assessment of current EOB analysis and other data analysis that may already being done by the managed care department; use data already available and where there are gaps, perform analysis needed.

• Manage billing team to ensure performance standards are met. Monitor and approve schedules and time, provide feedback and coaching as needed.

• Perform other duties as required.

• Must read and understand and adhere to all Physician Services policies and procedures.

• Practice and adhere to the Code of Conduct and Mission and Values statement.

EDUCATION & EXPERIENCE

• Bachelor’s degree or equivalent combination of education and/or experience.

• At least three to five years of medical billing experience along with prior supervisory experience with prior supervisory experience of at least three years. Experience in spine/orthopedics preferred.

• In-depth knowledge of healthcare reimbursement systems, including Medicare, Medicaid, and commercial payers.

• Strong understanding of healthcare coding, billing, and documentation requirements.

• Excellent leadership, communication, and interpersonal skills.

Benefits

Texas Back Institute, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.

• Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.

• Free counseling services and resources for emotional, physical and financial wellbeing

• 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service)

• Employee Stock Purchase Plan with 10% off HCA Healthcare stock

• Family support through fertility and family building benefits with Progyny and adoption assistance.

• Referral services for child, elder and pet care, home and auto repair, event planning and more

• Consumer discounts through Abenity and Consumer Discounts

• Retirement readiness, rollover assistance services and preferred banking partnerships

• Education assistance (tuition, student loan, certification support, dependent scholarships)

• Colleague recognition program

• Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence)

• Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.

Learn more about Employee Benefits (https://careers.hcahealthcare.com/pages/employee-benefits-and-rewards)

Note: Eligibility for benefits may vary by location.

Our teams are a committed, caring group of colleagues. Do you want to work as a(an) Director of Reimbursement where your passion for creating positive patient interactions are valued? If you are dedicated to caring for the well-being of others, this could be your next opportunity. We want your knowledge and expertise!

Physician Services Group (https://careers.hcahealthcare.com/pages/physician-services) is skilled in physician employment, practice and urgent care operations. We are experts in hospitalist integration, and graduate medical education. We lead more than 1,300 physician practices and 170+ urgent care centers. We are HCA Healthcare’s graduate medical education leader. We provide direction for over 260 exceptional resident and fellowship programs. We focus on carrying out value-added solutions. These solutions help physicians deliver patient-centered healthcare. We support HCA Healthcare's commitment to the care and improvement of human life.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

"Bricks and mortar do not make a hospital. People do."- Dr. Thomas Frist, Sr.

HCA Healthcare Co-Founder

If you are looking for an opportunity that provides satisfaction and personal growth, we encourage you to apply for our Director of Reimbursement opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. Unlock the possibilities and apply today!

We are an equal opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.