Oxford Immunotec, Inc.

  • Director, Reimbursement & Billing

    Job Location US-MA-Marlborough
    Posted Date 3 months ago(3/8/2018 3:31 PM)
    ID
    2018-1872
    # of Openings
    1
    Department
    FIN BOS - Accounting/Finance
  • Overview

    Responsible for providing operational leadership to the US reimbursement and billing operations to maximize revenue realization. Directs all aspects of the revenue cycle process and develops and implements reimbursement management and billing operation strategy. Has proven success in planning, executing, and managing reimbursement and billing operations, and works with little or no supervision. Collaborates closely with the accounting team to optimize revenue reporting and cash application and commercial team to ensure billing and reimbursement is aligned with sales and marketing objectives. Works closely with the payer relations manager.

    Responsibilities

    • Responsible for supervision of the rapidly growing billing and reimbursement department for multi-million dollar operation. Includes insurance verification, authorizations, and other documentation to support initial and subsequent billing, collections, AR, cash posting and patient files
    • Leads third party billing team to maximize revenue opportunities through outreach to government and commercial payers including obtaining coverage pre-authorizations and appeals in response to coverage denials
    • Ensures information system functionality is designed to support and enforce:
      • Coverage levels for all applicable CPT codes
      • Member ID guidelines at the plan level of each payer
      • Definition of appropriate collection efforts based upon denial, no reply and payment scenarios
      • Unusual filing or HCFA requirements by payer
      • Other information to enable or ensure payment or effective collection efforts
    • Incorporates new product billing into the Company’s systems and processes
    • Adapts reimbursement and billing processes and policies to effectively manage the integration of new products in new market segments into the revenue cycle process
    • Ensures timely revenue reporting to accounting each month; completion in not more than 4 business days
    • Supervises the US billing system administrator
    • Develops and prepares weekly metrics reports; modifies reports as needed due to changes in the business
    • Prepares monthly reports for management
    • Prepares quarterly reports for senior management and the audit committee of the Board of Directors
    • Ensures that billing policies and practices support patient and physician needs and support field sales efforts
    • Ensures compliance to applicable laws, regulatory standards, internal policies and third-party regulations and direct activities of multiple reports to ensure efficient and compliant operational performance
    • Provides oversight for charge entry, benefit verification, cash applications/balancing, billing and collection processes
    • Translates developed billing policies to a combination of staff instructions or system programming
    • Identifies and resolves payment issues with specific payers
    • Responsible for efficient and effective work process flows to maintain accurate claims submission and maximize cash collections achieving established payment, bad debt and contractual objectives
    • Assesses system capabilities and implements improvements
    • Effectively analyzes activity to identify obstacles to achieving established goals
    • Communicates billing, cash collection, unbilled and other goals to team, leadership, and external constituents
    • Ensures extensive training to new staff and continuing development for employees in areas of the system, policies and payer requirements
    • Evaluates and provides recommendations regarding staffing and volume growth plans
    • Actively partners with other departments especially the commercial organization including sales and marketing to ensure efficient and effective processes
    • Regular attendance and timeliness is essential

    Qualifications

    • Relevant Bachelor’s degree or equivalent combination of education and experience
    • 6 years’ experience in healthcare billing, and 3 years in management
    • Extensive knowledge  of all aspects in lab billing process and solutions
    • Meaningful experience in environments with significant numbers of payers
    • Working knowledge and experience with Accounting, Finance, bad debt and HIPPA
    • Experience successfully supporting launching and integrating new products with regards to billing requirements
    • Strong organizational, leadership and interpersonal skills
    • Ability to work well in a fast-paced, customer-driven/focused department
    • Significant experience working closely with commercial organizations including significant interface relationships with field sales, sales management, and marketing
    • Ability to analyze complex process flows and implement changes to improve staff efficiencies and results
    • Ability to hire, develop, and mentor staff for optimal performance
    • Excellent written and verbal communication skills, builds credibility, trust, and respect with others
    • Excellent analytical, prioritization, and organizational skills

    PHYSICAL DEMANDS: 

    The physical demands described within the Position Responsibilities section of this job description 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 duties of this job, the employee is regularly required to be independently mobile.  The employee is also required to interact with a computer, and communicate with peers and co-workers.

     

    5% travel required

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