The PFS Medicaid Billing and Resolution Manager reports directly to the PFS Director at Inova Health System, a multi-billion dollar integrated health care system serving more than two million people each year throughout the Washington, DC metro area and Northern Virginia. This Manager plays a key leadership role in providing excellent internal and external customer service, and optimizing the cash yield from patient financial obligations with regard to claims for service to government payers for INOVA's Revenue Cycle. This Manager will oversee the Government Payer Billing and Resolution staff that is made up of supervisors, billers and resolution staff. Success in this role will require strong team leadership, inter-departmental collaboration, and management skills for positive outcomes. Additionally, this manager must possess an extensive knowledge of CMS guidelines for hospital billing and payment methodologies to include Traditional Virginia Medicaid and Medicaid HMO and MCO plans.
Responsible for the day-to-day management of the Supervisors and Team members assigned. Provide support, education, and guidance to Supervisors and Team. Perform duties, as assigned by and act on behalf of the Director in their absence. Manager is responsible for the timely and accurate processing of claims by assigned Supervisors and staff monitored through productivity measurement, quality review and feedback. Able to support employees that process claims and/or perform follow-up for multiple payer types (Managed Care, Commercial, Medicare, Medicaid, Blue Cross, etc.). Assure all claims meet clearinghouse and/or payer processing criteria, are followed-up in accordance with Departmental and Contractual requirements and that payments and adjustments are handled properly. Provide Director with issues and potential resolutions regarding problems with the claims submission and payment process. Payer response reports, rejection reports and TRAC/QUIC work lists are worked timely and meet Departmental Productivity and Quality Review standards. Provide support, education, and guidance to Team. Perform duties, as assigned, in the absence of the Director. Assure appropriate and timely documentation of all account activity. Correspondence is handled appropriately. WIP counts completed timely. All required reports are filed timely and accurately. Provides direction and management to direct reports and all employees in department. Handles employee relations and staff development for direct reports. Develop goals and manages fiscal activities of the department.
Internal Number: 50373BR
About Inova Health System
Inova is a global leader in personalized health, which leverages precision medicine to predict, prevent and treat disease, enabling individuals to live longer, healthier lives. At Inova, we serve more than two million people each year from throughout the Washington, DC, metro area and beyond. Inova's mission is to improve the health of the diverse community it serves through excellence in patient care, education and research. At Inova, more than 16,000 employees demonstrate their commitment every day to providing the community with expert, world-class, compassionate patient care.