Billing and Contract Compliance Manager

This position is responsible for leading and planning the billing and program financial management compliance, and reporting billing and fiscal data to Executive Leadership. The individual is responsible for designing, implementing, and enforcing policies and procedures, and engineering effective billing and financial management processes across multiple contracts, in accordance with relevant Federal Register, District of Columbia Municipal Register requirements. This position is highly visible and requires a strong leader with the ability to prioritize, plan, and direct the department. This position requires the employee to oversight billing and fiscal compliance for Federal and State government contracts; and serve as Liaison between TCS and its external partners, Centers for Medicaid and Medicare Services (CMS) Department of Healthcare Finance (DHCF), DDS Contracts Administrator and Medicaid Waiver Chief; District of Columbia DDS Fiscal Intermediary.

ESSENTIAL JOB FUNCTIONS AND RESPONSBILITIES:

• Ensure the services and supported rendered by Total Care Services, Inc. are compliant with the rules and regulations set forth by the District of Columbia Healthcare Finance Administration, and the Centers for Medicaid & Medicare Services, and other state and Federal governing bodies.
• Generate reports on the status of existing agreements; follow up to ensure execution according to the negotiated contract terms; analyze and report on specific risks associated with contracts.
• Supervise and manage the team of billing and financial management staff; facilitate regular team meetings; implement performance measures for team; and evaluate and assess performance at regular intervals; implement progressive disciplinary action and recruit replacement staff, as necessary.
• Manage HCBS Medicaid Waiver Claims process including billing, payment posting, claims adjudication, adjustments, voids, reconciliation, analysis, and reporting.
• Manage the Human Care Agreement (HCA) budget updates, billing, and reconciliation, and CLIN expense tracking for persons receiving day and residential services. Ensure TCS adheres to the fiscal terms of its HCA contract.
• Manage Health Services for Children with Special Needs (HSCSN) billing compliance and fiscal oversight.
• Manage billing and compliance for new programs and state contracts.
• Manage general billing and collections processes; facilitate month-end closing of the billing; facilitate monthly reconciliation of billing; prepare weekly billing reports for Executive Leadership; and maintain billing dashboard.
• Manage Individual Financial Management compliance and oversight in accordance with TCS PI-9 Management of Individual Funds & Vinner Trust Policy; DDS Guidance on individual funds; and DCMR 29-1938 Home & Community Based Settings Rule.
• Monitor benefits and eligibility of persons served including Medicaid insurance, Trusts and entitlements, supplemental funding, housing and employment, and prior authorization.
• Track and Monitor prior authorization to ensure adequate funding for HCBS, RSA, HSCSN and other services.
• Plan and implement quality assurance measures for all department processes. Develop systems to improve current billing procedures and ensure efficiency. Partner with Controller and Center Director to Routinely update billing and operational policies and procedures.
• Support General Counsel and Executive Leadership TCS during regulatory audits and reviews including but not limited to, annual Bert Smith audit; DDS financial review; Provider Certification Review Financial Compliance; Centers for Medicaid & Medicare Services (CMS) audits; and Office of Inspector General (OIG).
• Perform research for Payment Error Rate Measurement (PERM) audits, and partner with Executive Leadership for response.
• Perform internal program integrity audits pursuant to Dept. of Healthcare Finance (DHCF) indicators and HR-5 False Claims Act Policy.
• Perform programs utilization reviews based on anomalies in services identified through reports, data, personnel action, and ISP compliance.
• Collaborate with finance and programs to develop corrective action plans relevant to agency or person supported fiscal deficiencies.
• Respond to the TCS Continuous Improvement Plan; and develop strategies to ensure agency compliance with our CIP relevant to fiscal improvement areas.
• Collaborate with TCS financial management team to prepare Medicaid Waiver cost reports pursuant to DCMR 29, Section 1937.1.
• Ensure TCS is utilizing the most appropriate billing software/systems; source new vendors, request demos; develop implementation or transition plan.
• Partner with Programs to implement electronic documentation software systems; source vendors; request demos; develop implementation plan.
• Implement Electronic