Director of Medicare Services (234) Cincinnati, Ohio


Job Title: Director of Medicare Services

Role: Management

Relocation Available: Yes

Industry: Healthcare

Location: Ohio

Town / City: Cincinnati

Job Type: Permanent full-time

Job description:

We are looking for someone with supervisory or management experience in Hospital based Medicare claims.


The Director of Medicare Services is primarily responsible for leadership and management of the daily workflow of the Medicare Advantage, Traditional Medicare and Post Discharge Review Departments.


Essential Duties and Responsibilities:


Interview, hire, train, audit and review team members

Lead, supervise, motivate and monitor team members to ensure compliance with company policies, procedures and standards

Support and assist team members with difficult issues concerning work and offer suggestions to assist in the process of underpayment reviews and collections

Investigate various issues with Medicare Advantage and Traditional Medicare carriers and contracts; respond to questions and resolve problems

Ensure team successfully achieves quality, productivity and collection goals

Participate in workflow examination or special projects as directed by management

Build strong, lasting relationships with clients, payors and personnel


Maintain regular contact with necessary parties regarding claims status including payors, clients, managers and other personnel

Direct claims to and coordinate and support specialty units

Attend client, department and company meetings

Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting

Perform duties and responsibilities of Claims Analysts as needed

Comply with federal and state laws, company and department policies and procedures


Essential Skills and Experience:


Minimum 3-years experience in an operational setting, preferably in managed care, hospital patient accounts or a multi-specialty physician office

Minimum 3-years management experience

Advanced proficiency in conducting Internet searches and Internet navigation through use of Internet Explorer

Knowledge of Medicare claims submittal process and procedures and medical forms (including UB04 and CMS1500)

High School diploma or equivalent

Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook

Analytical and problem solving skills

Organization and documentation skills to ensure timely follow-up and accurate record keeping

Mathematical skills:  ability to calculate rates using addition, subtraction, multiplication and division

Ability to read and interpret an extensive variety of documents such as contracts, claims, instructions, policies and procedures in written (in English) and diagram form

Ability to present written routine correspondence (in English)

Ability to present ideas on complex, detailed issues with ease

Ability to define problems, collect data, establish facts and draw valid conclusions

Ability to work on own with minimal supervision and use effective time management skills to complete tasks on time

Ability to travel by automobile or public transportation to visit worksites

Excellent leadership, interpersonal and communication skills, strong team player and commitment to company values

Strong customer service orientation


Non-Essential Skills and Experience:


Related Professional License/Certification(s)

Associate or Bachelor's Degree preferred but not required for review and consideration


1.  3 + years of experience in an operational setting in managed care, hospital patient accounts or a multi-specialty physician office.

2.  3 + years of management experience.

3.  Experience with Medicare claims submittal process and procedures for Hospital based Medicare claims.

4.  High School diploma or equivalent required, Bachelor's or Associate's degree preferred.