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VP of Revenue Cycle

Company: Kids Spot
Location: Houston
Posted on: January 16, 2022

Job Description:


  • Ensures due diligence in the research, analysis, and interpretation of patient medical records to identify and determine amount and nature of billable services, assignment and sequencing of appropriate diagnostic/procedure billing codes for the purpose of reimbursement, in compliance with requirements of third-party insurance payers and accreditation standards.
  • Manages the billing process to patients and third-party reimbursement claims; maintain supporting documentation files and current resident addresses.
  • Follow up on submitted claims; monitor unpaid claims, initiate tracers and resubmit claims as necessary.
  • Monitor billing to ensure compliance with legal and procedural policies and to ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices.
  • Monitor daily releases and correct errors.
  • Review and research inquiries regarding coding, charges, and denials on individual accounts.
  • Monitor medical records to identify lost revenue through inadequate documentation.
  • Credential providers and ensures consistent compliance with all payer contracts.
  • Prepare periodic reports and trend analysis.
  • Prepare special reports and research related projects as designated by management.
  • Download electronic payments made to us from carriers
  • Assist Demographic personnel as needed to determine patient eligibility
  • Process bad debts
  • Process End of Day and assist to Process End of MonthEDUCATION/EXPERIENCE:
    • 10 plus years Revenue Cycle Management (RCM) required
    • Medicaid and Commercial experience required
    • SPOT industry experience required
    • ABA industry experience preferred
    • Multi-state & multi-site experience required
    • Build, document, and maintain RCM/Billing workflows
    • Must partner with clinical team on coding & documentation requirements
    • Keeping up with and implementing CMS and payer coding and process updates
    • Track record of successful cash collections
    • Benchmark and minimize DSO, denials, rejections, and Billing team's productivity
    • Manage Charge Master, Gross to Net, Write-offs and refund policies, as well as other department policies and procedures
    • Self-starter, able to work with minimal to no supervision
    • Strong in SQL, Excel, and other MS Office programs such as VBA and/or other programming knowledge and experience
    • Excellent planning and organizational skills to balance and prioritize work.
    • Adhere to all Company policiesLANGUAGE SKILLS:Ability to read, analyze, and interpret common information, reports, and other documents. Ability to respond to common inquires or complaints from customers, regulatory agencies, or company representatives. Ability to effectively present information to management.PHYSICAL DEMANDS:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.While performing the responsibilities of the job, the employee is required to talk and hear. The employee is often required to sit and use their hands and fingers, to handle or feel. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and to stoop, kneel, crouch or crawl. Additionally, the employee must be able to lift about 20 pounds.WORK ENVIRONMENT:While performing the responsibilities of the job, these work environment characteristics are representative of the environment the job holder will encounter. Reasonable accommodations may be made to enable people with disabilities to perform the essential functions of the job.This job operates primarily in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.ESSENTIAL COMPETENCIES:Functional/ Technical SkillsAttention to DetailProblem Solving SkillsTime Management Skills

Keywords: Kids Spot, Houston , VP of Revenue Cycle, Executive , Houston, Texas

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