Government Payor Alliance Manager
DaVita
- USA
- $68,000-112,000 per year
- Permanent
- Full-time
- Develop and maintain a Local Coverage Decision (LCD) review process program based on risk analysis, resources, regulatory landscape, and direction of business
- Participate in and lead as necessary DaVita projects, work groups, and committees related to varied system or process implementation and maintenance initiatives; provide ongoing Billing and MAC Management input to operational activities
- Prepare communications to senior level management as required
- Develop and maintain a review and communication plan for all relevant bulletins, alerts, Listservs, etc. from CMS, MACs, and Medicaids
- Analyze possible impact of updates to DaVita; communicate to appropriate parties for further review; and participate as required with the development and implementation of action plans and work groups related to the above
- Develop and enhance relationships with the MACs and Medicaids including but not limited to arranging and attending live meetings, participation in MAC/Medicaid-led conference calls and related MAC/Medicaid Provider Outreach Groups
- Escalate issues to Payors and lead projects designed to reduce Medicare/Medicaid denials, rejections, and write-offs
- Serve as Liaison with Compliance, Medical Records, and other teams, partner as assigned to communicate new information as relevant, to identify areas of opportunity for process improvement, and to develop partnerships as needed to ensure accurate and timely Medicare Billing and follow up
- Provide guidance to ROPS Billing, Medical Records, IT, and other teams as required on Medicare and MAC regulations and practices
- Develop and maintain current knowledge of Compliance related issues, laws, and regulations related to Medicare and the MACs
- Manage other projects and tasks within the Team as assigned
- Travel required: up to 20%
- Bachelor’s degree in related area required
- 3-5 years’ healthcare reimbursement and revenue cycle management experience required including demonstrated knowledge of government regulations and non-government payor contracting
- Demonstrated knowledge of CPT/HCPCS and ICD-9 coding, medical records and/or claims processing required
- RHIT or RHIA certification preferred
- CPA or CIA (Certified Internal Auditor) preferred
- Experience with Process Improvement/CQI activities preferred
- Advanced computer skills and proficiency in MS Word, Excel, Access, PowerPoint, and Outlook required