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Genetics for Smarter Medication Management

Admera Health is seeking a Director, Revenue Cycle Management to join our growing team!

Title: Director, Revenue Cycle Management
Admera Health is a leading precision medicine company providing a suite of high-integrity pharmacogenomics (PGx) solutions, diagnostic testing, and biopharmaceutical research services. PGx, the study of how genes affect a person’s response to drugs, combines the fields of pharmacology and genomics to develop effective, safe medications and dosing recommendations tailored to a person’s genetic makeup. PGx testing may help reduce adverse drug reactions (ADRs), which some estimates place as the fourth leading cause of death – resulting in more deaths than lung disease, diabetes, AIDS, pneumonia, and accidents. For every healthcare dollar spent on medications, an additional 50% is spent on addressing ADRs. Admera Health’s flagship product, PGxOne™ Plus, is a comprehensive test built on the foundation of enabling smarter and safer medication management. The test incorporates next-generation gene sequencing design applications and expert data curation to deliver biological systems based medically actionable results. In addition to PGx services, Admera Health leverages existing knowledge and infrastructure to offer related clinical services and robust biopharmaceutical genomics solutions to researchers worldwide.

Purpose of the Position:

  • Responsible for management and support of enterprise-wide revenue cycle for billing and reimbursement. Compliance officer responsible for ensuring full Federal and State Compliance.

Responsibilities:

  • Directs and oversees the overall policies, objectives, and initiatives of the organization’s revenue cycle activities to optimize reimbursement and ensure compliance
  • Works with Upper Management/Leadership team regularly to discuss plans of action, issues, best practices, and compliance
  • Assesses and makes recommendations to improve efficiency of current systems/processes for the entire Revenue Cycle
  • Be the main contact point as it pertains to any Revenue Cycle Management questions, concerns, updates
  • Prepare monthly Revenue Cycle reports
  • Manages the internal billing staff
  • Reviews, designs, and implements processes surrounding billing, pricing, third party payer relations, compliance, collections and other financial analyses to ensure that revenue cycle is effective and properly utilized
  • Identify and analyze reimbursement trends to advise Upper Management and internal stakeholders accordingly
  • Perform prospective and retrospective chart audits, reviewing for accuracy and compliance
  • Work closely with billing vendor and reimbursement staff to address billing issues and streamline workflows
  • Work closely with Internal and External Sales Groups to ensure proper guidelines are followed and ensure any questions or concerns as they relate to billing and reimbursement are handled in a timely and efficient manner
  • Investigate billing issues due to potentially inappropriate documentation, coding, and/or medical necessity
  • Follow up with the referring physician offices and/or Internal/External Sales Groups to ensure corrective actions are taken
  • Investigate, evaluate, recommend, and implement coding and fee updates
  • Negotiate contracts with payers based on needs of the company
  • Perform other administrative and supervisory duties as assigned

Qualifications:

  • Bachelor’s Degree or relevant experience required
  • 10+ years’ experience Staff Management
  • 10+ years’ experience hands on billing & coding required
  • Strong understanding of the Revenue Cycle and ability to manage each aspect of it
  • Compliance Officer experience a plus
  • Experience in a molecular / genomics lab highly preferred
  • Audit Certificate highly preferred
  • Strong understanding of the Medical/Laboratory Billing Process and Industry Standard
  • Exceptional Knowledge of ICD’s, CPT’s, and LCD’s
  • Must possess strong knowledge of EOB’s and ERA’s with the ability to read and understand the follow-up steps required to mitigate any issues that need attention
  • Successful track record of negotiating with insurance companies to be brought in-network
  • Highly proficient in Microsoft Office, specifically Excel
  • Excellent interpersonal, verbal, and written communication skills
  • Ability to multitask and manage several projects concurrently
  • Ability to think outside the box
Admera Health employees have a winning attitude and champion innovation, teamwork and accountability through a results-oriented, customer-centric, and fun culture. We offer various health and financial benefits, learning opportunities, competitive compensation, rewarding bonus programs, and a wide range of work/life benefits designed to make your life easier.
For more information, please visit www.admerahealth.com.
To review and apply to our open positions, please visit www.admerahealth.com/careers.
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