• 01-Oct-2021 to Until Filled (CST)
  • NPP
  • Olivette, MO, USA
  • Full Time

For 35 years, HDIS has believed in treating our customers with the same compassion and care that we offer members of our own families. We believe in working to improve the quality of life for the users of our products and their caregivers by building long-term relationships. When HDIS is done, we want to have made a difference in our own lives and in the lives of millions of extended family members, our customers.

Job Summary

The Reimbursement Manager provides the daily operational leadership for the assigned team, including working closely with the Director of Reimbursement and frontline leaders to achieve strategic objectives.

Essential Functions

  • Promote and adhere to HDIS' Core Values: Integrity, Compassion, Excellence, Respect, and Commitment to Quality
  • Manage daily operations and task flow of the Non-Private Pay documentation, verification, billing, audit and medical records teams, including
    • Submission of documentation requests to physicians
    • Successful receipt of medical records/documentation/prescriptions from physicians
    • Timely and accurate verification of patient benefits across all payers (Medicare, Medicaid, commercial insurance)
    • Timely response to audit/medical record requests
    • Documentation management (filing, scanning, retrieval, etc.)
    • Submission of claims via EDI, website portal and HCFA 1500
    • Review of remittance advice and explanation of benefit documents
    • Denial reports
    • Payment posting
    • Credit and adjustment processing
  • Review reports to ensure all goals are being met
  • Point-of-contact for representatives needing assistance with issues/questions regarding documentation, verification, billing, audit and medical records
  • Engage in business process evaluation, establishment and re-engineering for the Non-Private Pay functions
  • Demonstrate understanding of the company's software/participate in on-going refinement of the application to facilitate productivity
  • Interview and make hiring recommendations for new representatives
  • Develop staffing plans, motivational programs and incentive plans to ensure key department metrics are met
  • Provide timely feedback and coaching as required and document employee conversations as needed
  • Provide daily, weekly, monthly and annual feedback to the representatives based on performance levels
  • Analyze errors and coach employee for performance improvements
  • Contribute to training, motivational and team building activities to maintain morale for frontline and supervisory staff
  • Work cooperatively with staff from all areas of the company to achieve company goals
  • Maintain a high degree of confidentiality pertaining to team member and customer situations
  • Demonstrate full understanding and acceptance of HDIS mission and vision
  • Others duties as assigned

Required Qualifications (Education, Prior Experience, Specialized Skills and Knowledge)

  • 5+ years of experience managing/supervising teams responsible for documentation, verification, medical records, billing or audit for Medicare, Medicaid and commercial insurance organizations
  • 3+ years of experience in Non-Private Pay
  • Ability to perform all duties of the Non-Private Pay Reimbursement representatives
  • Demonstrate a thorough understanding of the reimbursement process for a wide variety of Non-Private Pay payers including Medicare, Medicaid and commercial insurance organizations
  • Demonstrate a thorough knowledge of the rules and regulations associated with Medicare, Medicaid and commercial insurance organizations
  • Extensive problem solving capabilities
  • Strong written and verbal communication skills
  • Attention to details and accuracy along with strong organization skills
  • Proficiency with Microsoft products including Excel and Word

Physical Requirements

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions in this job description:

  • The employee is regularly required to stand, walk and sit, as well as talk and hear.
  • The employee is required to use hands to operate office equipment.
  • Specific vision abilities required by this job include close vision, distance vision, peripheral vision, and the ability to adjust focus.

HDIS is an equal opportunity employer. All employment decisions are made without regard to race, color, national origin, ancestry, sex, gender, gender identity or expression, sexual orientation, age, genetic information, religion, disability, medical condition, pregnancy, marital status, family status, veteran status, or any other characteristic protected by law. We will also consider for employment qualified applicants with criminal records in accordance with applicable law. HDIS also makes workplace accommodations for qualified individuals with disabilities as required by applicable law.

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