- Develop and maintain a Local Coverage Decision (LCD) review process program based on risk analysis, resources, regulatory landscape, and direction of business
- 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
- Prepare communications to senior level management as required
- Develop and maintain a review and communication plan for all relevant bulletins, alerts, Listservs, etc. from CMS, MACs, and Medicaids
- 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 and Medicaids including but not limited to arranging and attending live meetings, participation in MAC/Medicaid-led conference calls and related MAC/Medicaid Provider Outreach Groups
- Escalate issues to Payors and lead projects designed to reduce Medicare/Medicaid 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
- 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%
- Bachelor's degree in related area required
- 3-5 years' healthcare reimbursement and revenue cycle management experience required including demonstrated knowledge of government regulations and non-government payor contracting
- Demonstrated knowledge of CPT/HCPCS and ICD-9 coding, medical records and/or claims processing required
- RHIT or RHIA certification preferred
- CPA or CIA (Certified Internal Auditor) preferred
- Experience with Process Improvement/CQI activities preferred
- Advanced computer skills and proficiency in MS Word, Excel, Access, PowerPoint, and Outlook required
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Government Payor Alliance Manager - Malvern, United States - DaVita
Description
2476 Swedesford RdSTE 150, Malvern, Pennsylvania, , United States of America
At DaVita, we find that our best leaders are those who create an inspiring vision for the future and empowers their team to achieve success. They have always enjoyed tackling difficult problems and believe that the best way to solve them is through collaborative, team efforts. They take ownership of results and instill accountability in those they lead. They are driven, strong communicators, relationship builders, and find real fulfillment in challenging work.
Sound like you? Then you might be a great fit for Government Payor Alliance Manager with DaVita.
Here's what you can expect as a Government Payor Alliance Manager at DaVita:
Government Payor Alliance (GPA) Team optimizes revenue and patient advocacy through public policy monitoring, data analysis, and issue resolution. GPA supports internal teams to problem solve, identify potential legal and compliance risk, and manage initiatives across Revenue Operations (ROPS) and the Village through key relationships with external partners.
This position directs, develops, and enhances personal relationships with key individuals at the CMS, Medicare MACs (Medicare Administrative Contractors), and state Medicaid offices to include managed government payor relationships (Medicare Advantage/Managed Medicaid). Partners with ROPS Teams to ensure streamlined flow of information and efficient issue resolution.
This position serves as a liaison with Compliance, Legal, Medical Records, IT, Field Operations, Licensing and Certification and other teams as appropriate to ensure consistency in Government Payor billing and collection follow up practices.
Responsibilities include, but are not limited to:
At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed Diversity & Belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and an affirmative action employer. As such, individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic.
Salary/ Wage Range
Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies and experience and may fall outside of the range shown. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at
Government Payor Alliance Manager professionals in Malvern
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Farukh Naqvi
Manufacturing Business Partner