I am involved in a fca claim against an acute care hospital involving medicare and medicaid issues-- 1) upcoding, 2) improper status changes for inpatient only procedures, and 3) violations of 3 day inpatient stay rules for transfer to snf facilities. The us attny reviewing the case has hired nurse practitioners to advise the us attny and i would like a medicare coding expert to weigh in and possibly serve as the chief plaintiff's expert in the case.+4 Other Responses
Need help with properly coding services for a mental health and pain medicine practice. This is a single provider + support staff practice. We provide services in office, assisted living, custodial care and snf settings. Need to properly code e&m and adjunct services for billing to medicare and various california workers compensation payers. Looking for a consultant to assist with coding to maximize revenue while staying within medicare guidelines.+2 Other Responses
Medical Billing And Reimbursement
This full-time job post has been authorized by zintro.
Job position: director, billing & reimbursement
provides effective leadership and management of the reimbursement department in revenue management, medical insurance authorizations and managed care contracting.
Essential duties and responsibilities:
• develops, implements and manages the policy and procedures to ensure complete, accurate, and compliant processes that result in optimal collections and customer service performance for the organization.
• directs the complete revenue cycle process for reimbursement services: ensures timely authorization of tests; initiates prompt calls and manages and monitors contract status and compliance.
• is the key interface with xifin, our billing and collection service to ensure pricing is accurate and billing policies are followed.
• coaches, trains and mentors team to meet departmental goals.
• establishes performance metrics and reporting on progress to management on a weekly basis.
• identifies issues and opportunities within the reimbursement process and implements strategies to improve efficiency and effectiveness.
Knowledge, skills and abilities:
• third-party reimbursement, managed care organizations guidelines, medicaid & medicare regulation experience required, medical terminology experience preferred.
• ability to read, analyze and interpret documents, periodicals, professional journals, technical procedures and government regulations.
• strong financial, problem solving, and organizational skills.
• ability to read, interprets, and analyzes business and accounting documents.
• effective communication skills, the ability to provide clear and concise oral/ written information to internal/external customers.
• ability to maintain confidentiality and hipaa compliance practices.
• bs degree in business or a related field
• 8 years revenue cycle experience and 5 years in a leadership
role overseeing medical authorizations, managed care and reimbursement employees.
Candidate must be authorized to work in the u.S.A.+19 Other Responses