MANAGER GOVERNMENTAL A/R, FULL TIME, RIVERSIDE

The Manager is responsible for overseeing all billing functions and follow up for governmental payers.

The Manager is responsible for assisting in the overall planning, organization, direction and control of all Government Payers for four hospitals.  The total combined net patient services revenue for all three hospitals is $903.6M.  Directs and manages all billing process inclusive of EDI billing, assuring that existing systems are properly structured and maintained so that all compliance issues are identified & corrected prior to claim submission.  Ensures the daily claim edits are corrected timely allowing claims to be billed promptly and without error in a manner consistent with payer requirements inclusive of local, state, and federal laws and regulations.  Monitors all Medicare and Medicaid updates informing CHE NJ CBO Director and the Data and Analytics Manager of all changes to fee schedules, DRG changes, billing requirements, or any issue that will require a change to existing policies, processes, or systems.  Responsible for the management of personnel and accounts receivable for Medicare and Medicaid insurance groups to ensure all claims are paid within prompt pay guidelines and in accordance with individual payer contracts.  Implements & monitors internal controls inclusive of key performance indicators (KPI’s) and productivity standards.  Facilitates and participates in payer meetings using KPI’s to objectively explain challenges in the billing and follow-up processes.  Recommends solutions leading to cost savings and net