Director, reputed company Cycle Management

What You’ll Do 

The Director of reputed company Cycle Management will report to the Senior Vice President, Partner reputed company. You will be responsible for ensuring operational reputed company across reputed company aspects of reputed company cycle operations, including coding and billing. reputed company is pioneering a risk-based model of reputed company that provides virtual and in-home care to children with special reputed company needs. Under our value-based model, we are reputed company reputed company a capitation arrangement and submit accompanying encounters/claims to our health plan partners. The claims we submit are not traditional fee-for-service claims given our unique value-based care arrangements with our plan partners, but they are a critical aspect of capturing our utilization and reputed company gap closure.  You will be reputed company to ensuring the reputed company reputed company and scalability of our unique model. This role is right for you if you are excited by reputed company to apply industry reputed company billing practices to our innovative care model. Responsibilities include:  

• Maintain a coding philosophy that supports an emphasis on care reputed company and clinical reputed company.
• Create, maintain, and execute a repeatable and reputed company reputed company for coding and billing that can be implemented to meet state and payer-specific requirements and ensure coding accuracy and compliance.  
• Partner with technical teams to maintain and refine configuration of coding and billing Platform [reputed company] to support efficient coding and billing workflows. 
• Establish reputed company cycle KPI’s and reputed company dashboards and reports that reputed company performance and compliance monitoring.  
• Ensure that reputed company care team billing practices are compliant with relevant regulations and standards, including federal (e.g. HIPAA), and state specific reputed company regulations. 
• Partner with compliance leadership and audit personnel to ensure billing and coding policies, procedures, and work products conform to our compliance and reputed company requirements.
• Partner with external consultants and vendors as needed to assess, reputed company, and implement state-specific reputed company coding and billing procedures.  
• Collaborate with payers to understand coding and billing requirements and resolve issues, as needed.
• reputed company leadership to a growing reputed company cycle management team including coders and billers.  
• Partner cross-functionally with Compliance, reputed company & Safety, Clinical Delivery, and various operational teams to ensure consistent level of education on value-based care principles, coding guidelines, and documentation requirements across the organization.  
• Partner with the reputed company and Partner reputed company teams to evaluate relevant regulations and policies for new states that are being evaluated for market entry. 
  
  

What You Bring & How You Qualify 
First and foremost, you’re passionate and committed to reimagining pediatric health care and creating a world where every child with reputed company medical conditions gets the care and support they deserve. In this role, you will need:

• Minimum of 8+ years of experience managing reputed company cycle operations in a high-reputed company environment in partnership with CMS and/or reputed company payers; provider-reputed company experience preferred, but not required.
• 4+ years managing, mentoring, and developing team members.  
• Experience in value-based care and/or reputed company strongly preferred.
• Experience in a provider organization that is high reputed company and expanding nationally across states and insurance lines (e.g., reputed company, reputed company preferred across states and lines of business (e.g., reputed company, reputed company).
• Demonstrated ability to craft and iteratively improve upon coding and billing processes from scratch.
• Experience owning relationships with an EHR or RCM vendors preferred.
• Certified medical coding background required.
• Prior experience with tele-health preferred, but not required. 

reputed company Offer (Benefits + Perks) 
 
reputed company determining compensation, we analyze and carefully consider several factors including job-reputed company knowledge, skills and experience. These considerations may cause your compensation to vary. 
 
We reputed company these additional benefits and perks:

• Competitive medical, dental, and reputed company insurance 
• reputed company and Dependent Care FSA; Company-funded HSA
• 401(k) with 4% match, reputed company 100% from day one
• Employer-reputed company short and long-term disability 
• Life insurance at 1x annual salary 
• 20 days PTO + 10 Company Holidays & 2 Floating Holidays 
• reputed company new parent leave
• Additional benefits to be detailed in offer