Organization: Vision To Learn
Title: Director Public Reimbursement
Location: Los Angeles, CA
Job Type: Full time Exempt
Vision To Learn, a 501(c)(3) nonprofit organization that uses mobile vision clinics to provide eye exams and glasses to K-12 students in underserved communities, is seeking a Director of Public Reimbursement.
The Director of Public Reimbursement will manage Vision To Learn’s Public Reimbursement Team, and is responsible for credentialing Vision To Learn and its optometrists as Medicaid providers in each of the states served by the program, verifying which services can be billed to which payers, submitting and tracking claims, and reporting on these operations to senior staff.
Overseeing the Public Reimbursement Team, consisting of a Credentialing Specialist and a Billing Specialist, the Director of Public Reimbursement will be responsible for maximizing Vision To Learn’s capture of available public dollars supporting its service – principally, Medicaid reimbursement of children’s vision services. As Vision To Learn grows – the organization currently operates in 10 states – this will involve overseeing progress on multiple Medicaid and Managed Care Organization contracts, billing through a wide variety of portals and procedures, and maintaining relationships with insurance representatives to quickly troubleshoot and solve billing hurdles.
Qualified candidates will be able understand and contribute to an informed view of the high priority initiatives/projects that the Public Reimbursement Team is/should be addressing at any given time, such that reimbursement is optimized. Vision To Learn is a dynamic, extremely fast-growing non-profit and candidates should enjoy working in a team-based, collaborative environment where individual initiative as well as team coordination are essential.
Job Responsibilities:
· Oversee the completion, submission and tracking of initial VTL enrollment applications and re-enrollment applications to MCOs or vision subs for all regions Vision To Learn serves
· Oversee population and and preparation of enrollment applications for providers.
· Timely follow up on outstanding enrollment information and/or paperwork from providers.
· Review provider applications for accuracy and completeness.
· Track and follow up on enrollment or re-enrollment applications with payers until provider enrollment or re-enrollment is completed.
· Responsible for provider file maintenance with the payers, including but not limited to provider name changes, license updates, required attestations and any other payer required data.
· Establish and maintain professional working relationships with billing staff and work as a team to resolve billing issues related to enrollment in a timely manner.
· Facilitate VTL portion of roster reconciliation projects with payers.
· Meet targeted enrollment deadlines.
· Performs other reimbursement-related duties as requested.
Job Requirements:
· Have a working knowledge of the enrollment process and requirements.
· Knowledge of Medicaid and Medi-Cal enrollment standards.
· Knowledgeable with NPPES website and NPI accounts.
· Skilled in computer applications including MS Word, MS Excel, database administration and scanning applications.
· Excellent customer service skills.
· Ability to communicate effectively, both orally and in writing
· Strong organizational skills including critical thinking and the ability to produce and present detailed activity reports.
· Ability to use independent judgment to manage and impart confidential information.
· Ability to independently and consistently execute job responsibilities within a reasonable timeframe.
Qualifications:
College graduate or equivalent preferred. AS or B.S. degree in business administration or health care related field is a plus.
6+ years of enrollment experience including Medicaid experience.
3+ years of management experience.
Vision To Learn is committed to a diverse staff and to a culture that holds equity as a value and a priority. VTL welcomes applicants who bring a variety of perspectives, experiences, and competencies. People of color, women, people with disabilities, and LGBTQIA+ persons are strongly encouraged to apply. VTL is an equal opportunity employer and does not discriminate based on race, creed, color, religion, ethnicity, national origin, party or political affiliation, sex, sexual orientation or gender identity, age, disability, veteran status, marital status, or any illegal or prohibited factor. For More Information, Visit: www.visiontolearn.org |
