Program Specialist IV - Revenue Management
About The Position
Provides complex technical assistance and consultative services to facility reimbursement staff located in the 13 ICF/IID (Intermediate Care Facility for Individuals with Intellectual Disabilities) State Supported Living Centers and state-operated community facilities. Assists in planning, analyzing, developing, implementing, monitoring, and problem solving for multiple third party and non-third party reimbursement programs and automated systems. Provides support for use of mainframe and software applications and generates reports and data. Works closely with the Supervisor of the Revenue Management Unit on planning and development of residential ICFMR reimbursement programs, training Reimbursement Office staff at 13 State Supported Living Centers; ensures all claims for SSLC residents have been processed for the month; resolution of any payment discrepancies, rejected claims, and problems related with processes and policy; develops, maintains, implements, and interprets policies, procedures, and guidelines on administration, billing, and collection of Medicare Parts B and D, Medicaid, other Third-Party, and Non-Third-Party sources at ICFMR SSLCs. Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned.
Requirements
- Experience with automated or billing systems.
- Experience with reconciling or reporting accounts receivable.
- Experience with federal and state laws and regulations and HHSC rules, policies and procedures affecting third-party and non-third party reimbursement for services.
- Experience with various third-party programs such as Medicare, Medicaid, and private health insurance.
- Knowledge of federal and state laws and regulations affecting the collection of charges for agency services.
- Knowledge of agency programs.
- Knowledge of State funded Medicaid plans/programs
- Knowledge of electronic billing
- Knowledge of prior authorization for high radiology services
- knowledge of general SSA benefits
- Knowledge of agency rules related to ICF/IID.
- Knowledge of agency organizational structure.
- Knowledge of the principles and practices of public administration and management.
- Skill in written and oral communications.
- Skill in electronic billing systems
- Skill in use of a networked computer and software.
- Ability to establish goals and objectives.
- Ability to identify problems, evaluate alternatives, and implement effective solutions.
- Ability to explain policies and procedures to others.
- Ability to prepare concise reports.
- Ability to train others.
- Ability to plan, assign, and/or supervise the work of others.
- Ability to communicate effectively with others.
Responsibilities
- Plans and directs MR Reimbursement program development and implementation in State Office and out-stationed Reimbursement offices located in 13 State Supported Living Centers (SSLCs).
- Reviews/researches State and Federal laws, rules, and regulations for impact on reimbursement; plans, develops, implements, coordinates, maintains, and interprets, policies, procedures, and standards for ICF/IID Reimbursement program; and develops and maintains procedures and reports related to the use of the Claims2 Automated Patient Billing System.
- Identifies operational problems and provides assistance to Reimbursement Office staff in resolution of problems; interacts with management, staff, or customers to answer inquiries, discuss problems, develop resolutions, and report to management on status and issues; and coordinates with Internal Audit, Center for Policy and Innovation, ID facilities, and other agency management/staff on issues that impact SSLC revenue.
- Provides instruction and guidance on reimbursement to managers and staff and provides training to all Reimbursement Officers on all facets of billing and collection of revenue.
- Serves as liaison with HHSC, Social Security Administration, other agencies management and staff to coordinate program activities and resolve problems and represents the agency at meetings, conferences, committees, workgroups, and hearings to address significant issues.
- Evaluates program, procedures, and processes for effectiveness through review and reports results or make recommendations to resolve issues or improve performance.
- Prepares management reports, analyzes information to keep management informed, and responds to issues.
- Analyzes current/potential effects of current/proposed legislation, regulations, or court rulings on agency operations.
Benefits
- 100% paid employee health insurance for full-time eligible employees
- a defined benefit pension plan
- generous time off benefits
- numerous opportunities for career advancement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
