The Reimbursement Specialist assists with developing and implementing programs that will help to achieve the strategic goals and objectives of Lutheran Life Communities. This position works collaboratively with the Senior Director of Revenue Cycle, Revenue Cycle Supervisor, and community Executive Director to ensure overall revenue cycle goals are met. The Reimbursement Specialist also provides oversight and expertise to ensure Lutheran Life Communities is compliant with processes/policies and regulatory requirements. The Reimbursement Specialist is the Medicaid Subject Matter Expert and provides support to resolve all aspects of Medicaid issues. This person will also researches and analyze Medicaid and Private Pay accounts to ensure revenue cycle goals are met.
Essential Functions & Responsibilities:
- Collaborate with community Executive Director in efforts to recruit, interview, and final selection of new team members for Business Office.
- Oversee orientation and continued education to the Business Office.
- Subject matter expert on Medicaid and Private Pay billing and collections.
- Research changes with any state and federal regulatory requirements to adhere to strict compliance of all aspects of Medicaid programs.
- Participate in routine accounts receivable reviews to decrease and maintain current accounts receivable while providing ongoing follow up and support.
- Assist with optimization of work-flow processes between the Business Office Managers and the Central Billing Office, resulting in reducing accounts receivable balances and improved communication.
- Work collaboratively with the community Executive Director, Business Office Manager and Revenue Cycle Supervisor to achieve overall revenue cycle goals for the communities.
- Organize workflow and ensure that team members understand their delegated tasks.
- Ensure workflow processes are standardized and followed in the communities in order to reduce accounts receivable balances.
- Monitor team member productivity and provide constructive feedback and coaching.
- Collaborate with Senior Director of Revenue Cycle to develop action plan for all identified areas of opportunities at the community and follow up for community success.
- Able to travel 50% or more depending on business needs.
- Other duties as assigned.
- Bachelor’s degree or equivalent work experience.
- Minimum of five (5) years of experience working in long term health care, billing, collections, or related third party reimbursements and accounts receivable.
- Extensive experience with billing and collections for all payers, including Private, Medicare, Medicaid and Commercial Insurance.
- Experience with billing software.
- Ability to work effectively with an interdisciplinary team.
- Must be able to effectively train and mentor team members.
- Exceptional communication, influencing and partnering skills at all organizational levels.
- Demonstrated project management and organizational skills.
- Possess a customer service focus.
- Ability to define problems, analyze data, establish facts, and draw valid conclusions.
- Ability to read and interpret documents such as CMS regulations, Managed Care contracts and other instructions and procedure manuals.