Director of Billing in Rochester, New York at St Johns Health Care Corporation

Position Summary:

The Director of Billing is responsible for the strategic leadership, management, and oversight of all billing and revenue cycle operations for St. John’s Home, including Skilled Nursing Facility reimbursement, accounts receivable management, collections, claims submission, denial management, and regulatory compliance. The Director of Billing ensures the timely and accurate billing of Medicare, Medicaid, Managed Care, Hospice room and board, commercial insurance, and private pay accounts while optimizing cash flow and reimbursement outcomes.

Core Organizational Competencies:

· St. John’s Brand Characteristics - Embrace living by being Friendly, Respectful, Responsive, Compassionate, Innovative, and Fun towards elders, families, and colleagues.

· Teamwork - Actively participates. Assists team members; offers encouragement. Acknowledges/welcomes elders. Keeps team members informed. Recognizes achievements and efforts of others.

· Job Knowledge - Consistently demonstrates working knowledge of all aspects of the job. Remains current on job-related changes and trends.

· Planning/Organization - Demonstrates initiative; plans appropriately. Uses time, materials, and resources effectively. Organizes work to ensure commitment and priorities.

· Productivity - Consistently maintains high activity and efficiently produces acceptable volume of work. Consistently meets deadlines and commitments.

· Quality - Consistently produces accurate, timely work which meets required quality standards. Pays attention to detail. Sets high standards of performance for self and actively seeks continuous improvement. Provides elder-driven care.

· Reliability - Consistently delivers on commitments. Can be counted on to accomplish tasks without follow-up. Available when required by the elder or team and can be counted on to help or assist when needed. Responds on time.

· Demeanor (attitude) - Embraces change with optimism. Addresses concerns appropriately. Positively communicates. Good listener. Consistently maintains a positive demeanor.

Position Competencies:

· Payer relations and reimbursement strategy

· Medicare, Medicaid and Managed Care expertise

· Contract interpretation and payment variance analysis

· Denial management and appeals

· Revenue recovery and underpayment analysis

· Regulatory compliance

· Confidence in and collaborative approach to decision-making

· Interpersonal skills: support emotional, physical, and social well-being of team

· Leadership skills: provide consultation services to support residents and Core Team as needed, lead by example, distribute responsibilities among interdisciplinary team members

· Organizational skills: talent management (oversee staffing, hiring, performance improvement)

Position Responsibilities:

· Serve as the organization’s subject matter expert on all payer sources and reimbursement methodologies

· Monitor changes in Medicare, Medicaid, Managed Care, and commercial insurance regulations and communicate impacts to leadership and operational teams

· Review payer reimbursement trends and identify opportunities to improve net revenue and reduce reimbursement delays

· Develop and maintain strong working relationships with payer representatives and managed care organizations

· Collaborate with the Admissions and Clinical teams to optimize payer utilization and reimbursement opportunities

· Oversee resolution of complex payer disputes, underpayments, recoupments, and reimbursement discrepancies

· Direct appeal processes for denied claims and significant reimbursement issues

· Analyze reimbursement variances and implement corrective actions to improve collections and payment accuracy

· Provide leadership with regular reporting regarding payer mix, reimbursement trends, denials, collection performance, and financial risk

Physical Requirements:

· Light to moderate lifting up to 25 lbs.

· Sitting, standing, walking

· Transportation to multiple locations possible

· May be required to work flexible hours

Exposure to Conditions:

· Works in office areas as well as throughout the facility. Sits, stands, bends, lifts, and moves intermittently during work hours. Is subject to frequent interruptions. Communicates with multiple departments

Qualifications & Education Required:

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Accounting, or related field preferred. Equivalent experience will be considered.

• Minimum of 7-10 years of progressive experience in billing, reimbursement, accounts receivable, and revenue cycle operations, including at least 3-5 years in a leadership role.

• Demonstrated expertise in payer billing requirements, claims adjudication, and reimbursement recovery

• Proven ability to interpret payer contracts, reimbursement schedules, and billing guidelines to maximize organizational reimbursement

• Experience managing payer audits, denials, appeals, and revenue recovery initiatives

• Proven leadership track record of establishing billing controls and accountabilities related to collections

• Experience with electronic medical records and billing systems

• Strong analytical, organizational, and problem-solving skills

• Willingness to embrace and exemplify St. John’s Brand Characteristics

Preferred Qualifications:

• Health care billing and reimbursement experience with a strong focus on skilled nursing facilities or long-term care

• Knowledge of skilled nursing facility payer reimbursement methodologies and regulations

• Strong understanding of PDPM reimbursement and its impact on skilled nursing revenue cycle operations