Reimbursement Services Director jobs in Pittsburgh, PA

The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest® wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies.

Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help to ensure cardiac patients get the life-saving therapy they need. To date, the LifeVest WCD has been worn by hundreds of thousands of patients and saved thousands of lives.

ZOLL has been Pittsburgh’s Manufacturer of the Year, one of Western PA’s Healthiest Employers, and even one of Pittsburgh’s Coolest Offices. But it’s our unique opportunity to impact people’s lives that makes ZOLL the ideal place to build your career.

Job purpose

This position is responsible for leading the billing operations, claim audit processes, and systems implementation. The individual is responsible for designing, implementing and enforcing policies and procedures. This position is highly visible and requires a strong leader with the ability to prioritize initiatives, work cross-functionally to improve processes, and meet collection goals.

Duties and responsibilities

• Responsible for third party billing
  • Monitor and manage all third-party claims submissions
  • Requires expert knowledge in all local and regional government payer policies, including comprehensive knowledge of Medicare, Medicaid, and private health insurance regulations.
  • Requires knowledge and management of billing submission requirements across all payer categories
  • Works proactively with the Collections team to identify initiatives to lower denial rates
• Responsible for facility billing and collections
  • Monitor and manage accurate facility billing processes (hospital leases, SNF leases)
  • Lead initiatives to increase revenue capture when third party payers cannot be billed
• Responsible for claims quality and audit processes
  • Ensure billing processes are in compliance with governmental regulations, including documentation and claims submission standards
  • Monitor policies that may impact ZOLL from a compliance perspective, including but not limited to HIPAA, HHS OIG, ACHC
  • Oversee internal claims audit functions (both pre-bill audits and response to post-claim audits)
  • Develop proactive quality monitoring tools to lower payment issues associated with upstream errors
  • Ensure full reimbursement compliance and audit readiness at all times.

• Lead process automation and system enhancement initiatives
  • Oversee the processes related to functional specification requests for system enhancements
  • Lead cross-functional teams in prioritizing projects that require software or systems support
  • Prioritize and champion needed projects, working with both outside vendors as well as internal software teams to automate process steps as the organization scales.

Qualifications

• Graduate of an accredited college or university with a Bachelor’s degree in business, finance, or related field.
• Minimum of five (5) years medical billing required, preferably in a DME provider environment
• Demonstrated track record of process improvement
• Experience with systems implementations

Working conditions

This position is generally performed in a typical office environment that is usually quiet. Employee is expected to work collaboratively with team members, as well as able to work independently with limited supervision. Work will require significant computer and telephone work.

Physical requirements

While performing the duties of this Job, the employee is regularly required to sit, talk and hear. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 25 pounds.

Supervisory responsibility

Directly supervises Reimbursement Managers. Carries out supervisory responsibilities in accordance with the organization's policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems.

AAP/EEO Statement

ZOLL is committed to fostering an inclusive workplace, where unique identities, backgrounds, cultures, perspectives and experiences are respected and valued.

Equal Opportunity Employer – Disability and Veteran

ZOLL now mandates COVID vaccinations subject to legal exemptions.

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