Director, Billing and Credentialing (Finance)

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.

SUMMARY

The Director, Billing and Credentialing is responsible for assisting with all claims submission oversight, practice education of billing and coding changes, and group and provider credentialing activities with health plan payors on behalf of Physician practices that are owned or managed by the Physician Services team. The Director will engage with national, regional and state based payors representing all practices across the enterprise and interact with various U.S. Renal Care teams and leadership as may be required. In collaboration with the Physician Services operations team, the Director will ensure enterprise business objectives are executed in accordance with company policy and procedures to effectively collect all revenue owed through payor contracts, assist in the oversight and implementation of practice claims submission, and ensure all other Physician Services Revenue Cycle Management and billing objectives are met.

Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.

• Monitor all services to ensure timely and accurate Billing for medical services performed at all practices that work with Physician Services.
• Review Coding procedures and diagnoses and provide education and guidance to providers to submit claims accurately.
• Review any denials or correspondence from payers and respond appropriately.
• Following up on unpaid claims or claims that are held in Athena system
• Resolving billing issues or discrepancies and notifying management of any payer issues that should be addressed in contracting. Coordinate with Credentialing specialist to resolve any network issues with payors.
• Coordinate with Credentialing and Contracting Specialist to complete all credentialing for all providers with payers (initial and recredentialing) and complete work in Athena enrollment dashboards for pending credentialing items.
• Uploading and working unconfirmed deposits, missing remittance and other items in Athena that affect posting for services.
• Quarterly and as needed review, update and attestation for CAQH for all providers.
• Working with practice staff to appropriately handle patient billing inquiries.
• Work in Athena and remote charge capture software for billing activities- complete any necessary training and communicate needs for additional information as necessary with practice staff.
• Assists leadership with the administration and oversight of billing systems/tools.
• Build and maintain strong relationships with health plan payors and provider specialists.
• Collaborate with corporate and regional field Operations teams and leadership to establish billing KPIs ensuring optimal collections and effective revenue cycle management.
• Collaborate with the physician practices teams to assist with payor payment disputes and other projects as necessary.
• Provide support with organizational high-priority projects, as assigned.
• Actively participates in process improvement initiatives and enterprise Operational Excellence goals by assisting department leadership with various projects and supporting team objectives.
• Upholds management goals of corporation by leading staff in team concepts and promoting a team effort.
• Maintains effective personnel management and employee relations, including evaluating the performance of all personnel and coordinating with practices; approving and submitting all hours worked and counseling and disciplining employees.
• Recruits, trains, develops, and supervises personnel at the practices.
• Effectively communicates expectations; accepts accountability and holds others accountable for performance.
• Regular and reliable attendance is required for the job.