This position can be located in Tacoma, WA; Irvine, CA; Malvern, PA; or Brentwood, TN.
This position directs develops and enhances personal relationships with key individuals at the Medicare MACs (Medicare Administrative Contractors), develops and maintains a Local Coverage Decision Review Process, and partners with ROPS Billing Team to ensure streamlined flow of information and efficient issue resolution. This position serves as a liaison with Compliance, Legal, Medical Records, clinical teams, IT, ROPS (Revenue Operations), field operations, Licensing and Certification and other teams as appropriate to ensure consistency in Medicare billing and collection follow up practices. Position also includes problem solving and oversight of state Medicaids and Managed Medicaid.
- Develop and maintain a Local Coverage Decision (LCD) review process program based on risk analysis, resources, regulatory landscape, and direction of business
- Prepare communications to senior level management as required
- Develop and maintain a review and communication plan for all relevant bulletins, alerts, Listserves, etc. from CMS and the MACs
- Analyze possible impact of updates to DaVita; communicate to appropriate parties for further review; and participate as required with the development and implementation of action plans and work groups related to the above
- Develop and enhance relationships with the MACs including but not limited to arranging and attending live meetings, participation in MAC-led conference calls and related MAC Provider Outreach Group
- Identify key areas for improvement in Medicare MAC metrics; lead projects designed to reduce Medicare denials, rejections, and write-offs
- Serve as Liaison with Compliance, Medical Records, and other teams, partner as assigned to communicate new information as relevant, to identify areas of opportunity for process improvement, and to develop partnerships as needed to ensure accurate and timely Medicare Billing and follow up
- Provide guidance to ROPS Billing, Medical Records, IT, and other teams as required on Medicare and MAC regulations and practices
- Participate in and lead as necessary DaVita projects, work groups, and committees related to varied system or process implementation and maintenance initiatives; provide ongoing Billing and MAC Management input to operational activities
- Develop and maintain current knowledge of Compliance related issues, laws, and regulations related to Medicare and the MACs
- Manage other projects and tasks within the Team as assigned
- Travel required: up to 20%
Here is what you can expect when you join our Village:
- A "community first, company second" culture based on Core Values that really matter.
- Clinical outcomes consistently ranked above the national average.
- Award-winning education and training across multiple career paths to help you reach your potential.
- Performance-based rewards based on stellar individual and team contributions.
- A comprehensive benefits package designed to enhance your health, your financial well-being and your future.
- Dedication, above all, to caring for patients suffering from chronic kidney failure across the nation.