Director, Revenue Cycle & Billing Operations
About Cohen Veterans Network:
Cohen Veterans Network is a 501(c)(3) not for profit philanthropic organization whose mission is to improve the quality of life for veterans, including those from the National Guard and Reserves, and their families. CVN works to strengthen mental health outcomes and complement existing support for post-9/11 veterans and their families. Our vision is to ensure that every veteran and family member is able to obtain access to high-quality care that enables them to lead fulfilling and productive lives.
As a Member of the Cohen Veterans Network Team:
The Director of Revenue Cycle & Billing Operations will serve as the liaison between CVN Central Office and the Cohen Veterans Network clinics on all operational matters related to managed care. This role will serve as the managed care process expert to work between all CVN departments (e.g., Network Systems, Clinical Programs, Communications and Operations, etc.) and CVN clinics.
As the Billing process expert, the Director of Revenue Cycle & Billing Operations responsibilities include, but are not limited to:
- Supporting clinic-specific implementation of CVN billing policies as outlined in the CVN Billing Manual and other related policy and procedures manuals to ensure that best practices are utilized.
- Providing core billing training as outlined in the CVN Billing and EHR Manuals.
- Supporting the Revenue Cycle Manager with Revenue Cycle Management implementation and problem-solving, as needed.
- Identifying and communicating opportunities for process improvements related to CVN’s billing practices. Offering CVN clinics end-to-end billing process flow consultation (payor information gathering, client benefit verification, client cost sharing management, clinical documentation, data verification, claims submission, claims denial rework, etc.).
- Leading and supporting all credentialing activities with payors for CVN Central Office national payor contracts, including supporting CVN clinic partner with regional payors credentialing and elevating contracting issues as needed.
- Serving as the primary point of contact “troubleshooter” related to all clinic billing operations and facilitates problem-solving and operational issues through collaboration with clinic partners and internal stakeholders.
- Offering ongoing support and interpretation of CVN billing policy to support clinic billing beginning-to-end operations in collaboration with all related departments, contractors and vendors.
- Overseeing the implementation of and all operational procedures for the CVN managed care contracts. Supports Revenue Cycle Manager, by developing key billing KPI’s and frequent reporting that provides insight to patient accounting included billing, collections, and reimbursement analysis.
- Overseeing provider credentialing with the support of the Revenue Cycle Manager, as needed, through ongoing monitoring of the CVN credentialing data grid and reviewing credentialing reports. When applicable, submit new or updated credentialing information directly to payors or alert Clinic POC and/or clinician to submit required credentialing data directly to payor according to payor’s required format/method (i.e., via provider portal or on provider paper forms).
- Participating in special projects as needed, including evaluating feasibility of managed care program development as it pertains to payer operational requirements and related policies.
- Staying up-to-date on billing trends and making recommendations in anticipation of, or in response to, a changing managed care environment.
- Ensuring policies and procedures are current and in compliance with applicable regulations and standards.
To Succeed in This Role, You Must Embody:
- A team player, but also someone who can successfully complete tasks individually. You can consistently complete daily tasks and handle projects with minimal supervision.
- A strong ability to cope with change. You think about problems and tasks in novel, creative ways when circumstances unexpectedly change.
- An eye for detail. You notice small, but important things, which other people might not notice.
- An ability to adapt. You display confidence in your expertise, but you also are flexible in your approach in a rapidly changing environment.
- Thirst for knowledge. You are eager to learn and stay abreast of the cutting-edge developments in your field.
- Visionary view on challenges and solutions. You are willing to be a part of a small, dynamic, and innovative team while contributing your voice to all aspects of the CVN and its growth.
When you Joing the Team, You Will Have the Opportunity to:
- Build relationships with a variety of people. You will constantly be working with others on projects, whether it is another individual at the CVN or an affiliate.
- Hone your communication skills. You will be one of the few connection points between every stakeholder in the project management process. You will develop your own style for communicating effectively, accurately relaying the feedback of others, and advocating for those who are absent from crucial conversations.
- Tracking project status and managing processes efficiently. You will grow your eye for detail and your ability to anticipate by alerting others to opportunities and potential roadblocks so processes move smoothly.
- Bachelor’s Degree in related field; Master’s degree preferred
- 5 – 10 years’ experience in payer or third-party contracting, negotiating, reimbursement, and analytics experience particularly with TRICARE, the Department of Veterans Affairs, and/or other private payers.
- Extensive knowledge in managed care operations and process and healthcare reimbursement
- Highly knowledgeable in Managed Care delivery systems, forms, reports, etc.
- Ability to work in data systems/Electronic Health Records (EHR)