ACO Billing Consultant
We are seeking an experienced ACO Billing Consultant to join our team. The ideal candidate will have a strong background in healthcare billing, particularly within the context of Accountable Care Organizations (ACOs).
Responsibilities:
- Analyze and optimize billing processes for ACO-affiliated healthcare providers.
- Ensure compliance with ACO regulations and guidelines for billing and reimbursement.
- Coordinate with healthcare providers to implement efficient billing practices that align with ACO goals.
- Monitor and report on billing performance metrics related to ACO quality measures and cost savings.
- Identify and resolve billing discrepancies and denials specific to ACO arrangements.
- Provide training and support to billing staff on ACO-specific billing procedures.
- Stay up-to-date with changes in ACO regulations and reimbursement models
- Collaborate with other departments to improve overall ACO performance and financial outcomes
Requirements:
- Bachelor's degree in Healthcare Administration, Finance, or related field
- Minimum of 5 years of experience in healthcare billing, with at least 2 years of experience working with ACOs
- In-depth knowledge of Medicare billing rules and regulations
- Proficiency in medical coding (ICD-10, CPT) and understanding of their impact on ACO performance
- Strong analytical and problem-solving skills
- Excellent communication and interpersonal abilities
- Experience with healthcare billing software and electronic health record (EHR) systems
- Familiarity with value-based care models and population health management
- Preferred Qualifications: Master's degree in Healthcare Administration or related field
- Certifications such as Certified Professional Biller (CPB) or Certified Professional Coder (CPC)
- Experience in developing and implementing billing policies and procedures
- Knowledge of data analytics tools for healthcare billing and performance tracking
The ACO Billing Consultant will be crucial in optimizing billing processes to support the ACO's goals of improving healthcare quality while reducing costs. This position requires a deep understanding of both traditional fee-for-service billing and value-based care models unique to ACOs.