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Reimbursement and Billing Director

Employer
Kerecis
Location
VA
Start date
Feb 21, 2024

View more

Discipline
Administration, Finance
Required Education
Bachelors Degree
Position Type
Full time
Hotbed
BioCapital

Description

The Reimbursement and Billing Director oversees Benefits Investigation (BI) and Field Reimbursement and is responsible for the strategic development of building a highly functional reimbursement team that improves our value proposition for our customers. This includes collecting and implementing improvement opportunities, solving customer-related reimbursement issues, proactively training customers on Kerecis reimbursement, providing reimbursement training to our salesforce, and creating standard operations that can be managed using Key Performance Indicators. The Director manages the team supervisors, who in turn are responsible for reimbursement issues pre-application and supporting client billing issues post-application, respectively.  

An essential member of the Wound team, the Director reports to the COO and works in close collaboration with senior Wound Sales management with the clear goal of supporting revenue growth through reimbursement support to field sales.

This full-time role is based on site in a Kerecis office.

Responsibilities

  • Oversee the entire reimbursement process from inbound BIs to billing and reimbursement.  
  • Coordinate and align the BI and FR teams to optimize and synchronize results for Sales, clients, and patients
  • Ensure the teams are fully and properly trained
  • Ensure sufficient staffing of the BI and FR teams commensurate with the growth of the Wound sales team and client base
  • Ensure proper usage of Fishurance, Kerecis Current, and other internal systems
  • Ensure that turnaround times align with determined metrics; establish new metrics as needed
  • Coordinate with the Policy team to adjust investigations with policy changes
  • Ensure that the teams follow up rapidly on any issues or complaints from any stakeholders, including clients and Sales
  • Ensure HIPAA compliance within the BI and FR teams

Benefits Investigations

  • Oversee the BI supervisor 
  • Coordinate with the Artificial Intelligence (AI) developer to ensure that the AI engine is updated and maintained

Field Reimbursement

  • Oversee the FR supervisor
  • Advise the Policy team on suggestions and changes noted in the field
  • Train clients on Kerecis Current 
  • Increase adoption of Kerecis Current
  • Assist clients for accurate billing of Kerecis products
  • Manage the FR team to do client visits, business reviews, etc.
  • For identified Enterprise Accounts, create and implement a proactive enterprise billing review program

Requirements

Competencies

  • Experience with Medicare and private insurance reimbursement
  • Experience in the Skin Substitute a plus

Education & Experience

  • Bachelor’s degree or equivalent experience
  • Experience managing managers and detailed processes
  • Experience in customer service and other client facing roles

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibili¬ties that are required of the employee for this job. Duties, responsibilities and activities may change at any time. Kerecis is an equal opportunity employer.

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