Manager of Reimbursement

The Cardiac Management Solutions division of ZOLL Medical Corporation develops products to protect and manage cardiac patients, including the LifeVest® wearable cardioverter defibrillator (WCD), the ZOLL cardiac monitor, and associated technologies. Heart disease is the leading cause of death for both men and women in the U.S. At ZOLL, your work will help to ensure cardiac patients get the life-saving therapy they need. To date, the LifeVest WCD has been worn by hundreds of thousands of patients and saved thousands of lives. ZOLL has been Pittsburgh’s Manufacturer of the Year, one of Western PA’s Healthiest Employers, and even one of Pittsburgh’s Coolest Offices. But it’s our unique opportunity to impact people’s lives that makes ZOLL the ideal place to build your career.

Job purpose

Manages submission processes where authorization and re-authorization are needed.   Works in collaboration with the National Accounts, Sales, and internal reimbursement teams to meet plan requirements and develop new processes that may meet plan and ZOLL needs more effectively.

Duties and responsibilities

Manages team to ensure that the responsibilities of each are completed in a timely and accurate manner.  These will include but not limited to:

• Oversee timely completion of all authorization, documentation, and order submission to ensure no delay in revenue cycle
• Provide consistent feedback to employees regarding performance, oversee department functionality, and ensure quality results delivered to team monthly.
• Clinical Updating:  Assist team members with clinical interpretation of patient’s record during  authorization process.
• Client/Physician/Sales Interaction:  Contact clients, physician offices, and Sales Representatives to relay and/or obtain pertinent information and/or documents to effect clearance of new referrals.
• Monitors and reviews all revenue goals for accurate and timely booking of all sales activity to assist in meeting all department and company goals

• Develop/ improve statistical performance measures for department and demonstrate ability to develop same metrics for performance review of individual staff goals.
• Responsible for designing and recommending improved processes or operational policies and works with Senior Management and peers to refine and implement those changes.
• Refine standard authorization, re-authorization, and plan of care tools and procedures to streamline processes with health plans, delivering required clinical data clearly and correctly the first time
• Identify payors where additional controls may be required and conversely, where controls may be too strict
• Recommend and implement changes where required to improve approval and compliance rates with plan or internal requirements
• Measures, tracks and reports performance against standards
• Responsibility for new hire training and development for the team
• Maintain communication with other areas of Reimbursement and Customer Support
• Supervise, motivate, and monitor staff to ensure compliance with procedures and standards
• In conjunction with department Supervisors; interview, hire, train and review all eligible personnel
• Develop direct reports through utilizing development plan, career path exploration, succession planning
• Participate in cross functional meetings and presentations
• Maintain up-to-date information for all Payers via internal resources used by reimbursement team
• Perform monthly 1:1s with direct reports
• Monitor department overtime and ensure ROI for that time is at acceptable levels
• Set department appropriate objectives for all levels of department to increase accountability and measure performance
• Conduct annual performance reviews for direct reports
• Other duties as assigned.

Qualifications

Qualifications include:

• Assoc. or Bachelor’s degree in business, finance or related field preferred.
• 3-5 years experience in medical insurance verification, prior authorization and medical claims processing.
• Strong negotiation skills.
• Experience working with all payer types to include Medicare, Medicaid and third party commercial and commercial insurance companies
• Superior communication and customer service skills
• Ability to handle multiple tasks simultaneously under strict deadlines
• Proficiency in MS Office Suite
• Experience in provider appeals with all payer types
• Leadership/ Management experience

Working conditions

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 The noise level in the work environment is usually quiet.

Physical requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this Job, the employee is regularly required to sit and talk or hear. The employee is occasionally required to stand; walk and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds.

Supervisory responsibility

Will have direct reports

AAP/EEO Statement

ZOLL is committed to fostering an inclusive workplace, where unique identities, backgrounds, cultures, perspectives and experiences are respected and valued.

 Equal Opportunity Employer – Disability and Veteran