Reimbursement Services Director directs and supervises the activities of the claims and provider reimbursement personnel. Handles third-party reimbursement for services rendered to patients. Being a Reimbursement Services Director sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. Monitors, evaluates and reviews all cost reporting in support of reimbursement claims. Additionally, Reimbursement Services Director develops policies and procedures compliant with fiscal and regulatory requirements. Oversees the collection of statistical and financial data needed for preparing annual and monthly health insurance reports. May require an advanced degree. Typically reports to top management. The Reimbursement Services Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Reimbursement Services Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Employee provides billing processing and follow-up related to reimbursement of funds for the majority of agency fees including all State Plan Option Medicaid, MR Waiver Medicaid, Medicaid Taxi, Medicare, and managed care contracts. Work involves performing Utilization Reviews to insure that proper documentation supports each billing, along with the coordination of Medicaid, Medicare, and all managed care billings, including the tracking of client usage so that stated limitations to treatment are not exceeded. Employee is responsible for researching problem accounts and taking appropriate action, and for providing direction to other staff relating to third party insurance follow-up. Employee is also responsible for maintaining files and records.
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