RN / Director of Nursing Job in Houston, Texas
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Description
Standard Qualifications: The Payment Resolution Director is responsible for overseeing the remittance advice discrepancy function, which includes the collection of disputed underpayments and the processing of refunds of overpayments. This individual is responsible for consistent application of all standard A/R and Accounting processes, and for accurate and timely discount and allowance calculations, analyses and reconciliation of accounts receivable related to discrepancy payments and denials. As part of this role, this individual must demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner. Duties (included but not limited to): - Oversee the activities and management related to Payment Compliance discrepancy inventory, ensuring processes are performed efficiently, effectively and accurately. - Establish controls and review mechanisms for SSC policies and procedures. - Ensure timely submission of re-considerations, payer packages and liquidation of discrepancy inventory. - Monitor, trend and communicate with SSC, facility and corporate leadership, regarding trends, new inventory fluctuations and outstanding inventory identified via EDW, Vista, Visual Insights and other denials tools reports. - Demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner. - Understand and communicate contract specific issues related to the resolution of disputed payments, discount and allowance calculations for a variety of payers such as Medicare, Medicaid, HMOs, PPOs, IPAs, employers, etc. - Oversee management of personnel, providing recommendations for hiring, promotion,salary adjustment and personnel action where appropriate. - Follow escalation protocols to include Attorney, Corporate Dispute Resolution, Strategic Pricing and Analytics and Corporate Payment Compliance. - Participate in Joint Operating Committees (JOC) with payers, ensuring partnership in inventory resolution. - Oversee all reconciliation activities for inventory. - Proactively ensure training of all employees, including identification and communication of any operational gaps identified in day to day activities. - Identify and implement process improvements to lower billing costs and improve services to facility customers - Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement" - Other duties as assigned
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