Apria Healthcare

  • Mgr Reimbursement Compliance

    Requisition ID
    2020-9032
    # of Openings
    1
    Category
    Legal/Compliance
    Location : Location
    US-CO-
    Full/Part Time
    Full-time
  • Job Summary

    With over 300 locations across the US, Apria Healthcare’s mission is to improve the quality of life for our 1.8 million patients at home by providing home respiratory services and select medical equipment to help them sleep better, breathe better, heal faster, and thrive longer. Additional information can be found at www.apria.com.

     

    JOB SUMMARY

    This position oversees regulatory and reimbursement compliance by conducting audits of field branches and billing centers. Responsible for reviewing and responding to audits from external payors and prepares written reports of audit findings. Works with the Legal department to conduct compliance investigations and with revenue management to ensure applicable computer systems and processes support regulatory and reimbursement compliance. Provides training to the field as needed and works to resolve compliance issues.

     

    ESSENTIAL DUTIES AND RESPONSIBILITIES

    • Conducts regulatory and reimbursement compliance assessments/audits. Prepares written reports and follows progress to ensure compliance with payor and company policies and procedures for all product lines.
    • Communicates and reinforces payor and company policies and procedures.
    • Prepares and reviews documentation for all external audits, including Medicare, Medicaid or other insurance payors.
    • Prepares written reports and follows progress to ensure compliance with payor and company policies and procedures for all product lines. Reviews all documentation to ensure 100% compliance.
    • Reviews communication to field personnel, policies and procedures, and educational materials prior to rolling them out to the applicable employees.
    • Works with the Legal department on reimbursement compliance investigations to accumulate and interpret detailed claims/supporting documentation information.
    • Conducts reimbursement compliance training on-site, via conference call and through seminars to customer service (admissions) and accounts receivable management staff (CCC), as well as sales and operations staff, in accordance with all reimbursement updates and regulatory compliance procedures as required.
    • Identifies and resolves reimbursement billing / payment problems with Medicare/ Medicaid and other payors as necessary.
    • Performs data entry and tracking of all assigned audits.
    • Monitors payment and denial trends through follow up of assigned audits and reports findings as required.
    • Punctuality and reliable, consistent attendance
    • Performs other related duties as directed by manager.

     

     

    SUPERVISORY RESPONSIBILITIES

    • This position manages all subordinate staff of the department and is responsible for the performance management, hiring, and discipline of middle management within the department.

    Minimum Required Qualifications

    MINIMUM REQUIRED QUALIFICATIONS

     

    Education and/or Experience

    • Bachelor’s Degree is required.
    • At least five years of related experience is required.

     

    • Minimum one years of leadership experience.

     

    Certificates, Licenses, Registrations or Professional Designations

    • N/A

     

     

    SKILLS, KNOWLEDGE AND ABILITIES

    • Proven leadership and negotiation skills required.
    • Proven training and written/verbal communication skills.
    • Familiarity with medical terminology.
    • Ability to interpret regulations and implement as required by the Company.
    • General understanding of health and related types of insurance coverage, as well as the managed care industry and its operations.
    • General understanding of contracting structures.
    • Business Acumen
    • Strategic Thinking
    • Problem Solving/Analysis
    • Financial Management (Budgeting)
    • Project Management
    • Personal Effectiveness/Credibility
    •  

    Computer Skills

    • Advance skills in Access, Excel, PowerPoint, MS Project, Visio, Word

     

    Language Skills

    • English (reading, writing, verbal)

     

    Mathematical Skills

    • College level mathematical proficiency, with a strong ability to understand, interpret and develop spreadsheet data.

     

    PHYSICAL DEMANDS

    This is a stationary position that requires frequent sitting or standing, repetitive wrist motions, grasping, speaking, listening, close vision, color vision, and the ability to adjust focus.  It also may require occasional lifting, carrying, walking, climbing, kneeling, bending/stooping, twisting, pulling/pushing, walking, bending, stooping, and reaching above the shoulder.  Employees in this position must be physically able to efficiently perform the essential functions of the position. Reasonable accommodations will be provided to assist or enable qualified individuals with disabilities to perform the essential functions of the position.

     

    WORK ENVIRONMENT

    Work is performed in an office setting with exposure to moderate noise. 

     

    TRAVEL

    Occasional travel to attend training is required

     

    The essential duties and responsibilities, physical requirements, and work environment described above are representative of those typically required for this position but may vary depending on staffing and business needs at specific locations. The inclusion or omission of a specific duty or physical requirement is, therefore, not determinative of whether that function is essential to a specific individual’s position.

     

    EEO Statement

    As an EOE/AA employer, Apria Healthcare is committed to providing all applicants and employees with equal access to employment opportunities, regardless of sex, race, age, color, national origin, disability, pregnancy, religion, genetic information, sexual orientation, transgender status, gender identity, marital status, veteran status, or any other characteristic protected by federal, state, or local law.  Apria Healthcare shall abide by the requirements of 41 CFR 60-300.5(a) and 60-741.5(a). These regulations prohibit discrimination against qualified individuals on the basis of protected veteran status or disability, and require affirmative action by covered prime contractors and subcontractors to employ and advance in employment qualified protected veterans and individuals with disabilities. AA/EOE, M/F/Disability and Vet

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