Manager, Payor Policy & IQA

Billing Quality Manager

This employee manages multiple teams critical to the billing quality for all DME and Oxygen equipment, drugs, supplies, and services.

Responsibilities include:

• Overseeing payor contract updates in the EMR, ensuring government payor updates are communicated and implemented in a timely and effective manner, overseeing special projects related to billing quality, managing internal billing quality assurance reviews, ensuring that projects and assigned tasks are completed timely with accuracy and in accordance with the CIA structure, as well as following all payor and state guidelines
• Acting as SME for all payor policy-related topics as needed
• Working closely with Chief Compliance Officer on special projects as needed

Job functions include:

• Serving as the company-wide liaison for payor issues, working with Operations, billing offices, and payors to assist in resolving payor issues/concerns that arise
• Overseeing the Vent Queue Team
• Overseeing the contract review team to ensure that payor contracts are being reviewed timely and accurately in accordance to the guidelines set in place
• Overseeing company-wide assigned projects and assignments
• Working with applicable departments to ensure that changes in policies are being addressed timely
• Monitoring and maintaining all payor relationships ensuring all state, federal, and local government billing requirements are met while working through the assigned projects
• Assisting with writing and developing of policies and procedures
• Liaison for any CIA and internal audits
• Managing internal monthly and ad hoc billing quality reviews, overseeing the review process, data collection, delivering results, and education
• Assisting in identifying areas that need to be reworked or addressed
• Resolving employee issues as they apply
• Delivering directives from the Corporate office as they apply
• Communicating with Executives, Legal, Compliance, and any applicable parties pertaining to the centralized billing departments

Education:

• Associate's Degree or equivalent from two-year college or technical school, Preferred

Work Experience:

• 2-3 years, Required

Knowledge, Skills, and Abilities:

• Read, analyze, and interpret general business periodicals, professional journals, technical procedures or correspondence, payor contracts, fee schedules and policies, state and federal healthcare billing guidelines, and procedure manuals
• Effectively present information and respond to questions from groups of managers, clients, vendors, Executives, and other stakeholders
• Work with and apply mathematical concepts such as probability and statistical inference, and fundamentals of concepts such as fractions, percentages, ratios, and proportions to practical situations
• Define problems, collect data, establish facts, and draw valid conclusions