Director of Public Healthcare and Payor Compliance

The Kestra team has over 400 years of experience in the external and internal cardiac medical device markets. The company was founded in 2014 by industry leaders inspired by the opportunity to unite modern wearable technologies with proven device therapies. Kestra’s solutions combine high quality and technical performance with a wearable design that provides the greatest regard for patient comfort and dignity. Innovating versatile new ways to deliver care, Kestra is helping patients and their care teams harmoniously monitor, manage, and protect life.

Reporting to the Vice President of Revenue Cycle Management, and with strong collaboration with the Legal Team, this position is responsible for ensuring the Company maintains compliance with all Federal, State and Commercial reimbursement contracts and programs and provides regular updates to management regarding existing compliance requirements and changes in the regulatory environment. Further, this position will also be responsible for compliance functions related to Medicare and Medicaid compliance within the Company, including managing and responding to all audit inquires of governmental entities and commercial payors.

ESSENTIAL DUTIES

• Obtain and maintain all required federal & state licensing required for product reimbursement.
• Own accreditation activities of KMTS as required by federal and state programs.
• Conduct file audits by region and payor (quarterly rotations) to include reporting of results and follow-up training as required. Present findings to the Compliance Committee.
• Review all payor contracts and ensure that KMTS meets all designated requirements in the areas of reimbursement including, but not limited to, internal audits, third-party service arrangements, timely filing, and claim reporting. This information will be shared with the various responsible departments within KMTS.
• Develop a database of payor policy and billing guidelines to support all KMTS functions involved in reimbursement.
• Manage the maintenance of payor contract requirements to include both reporting and renewal requirements Including regular reporting of contract compliance status. Including regular reporting of contract compliance status.
• Oversee the initial submissions and renewals of all state Medicaid programs and monitor continuing compliance with such programs.
• Monitor trends in regulatory policies, through attendance with Payor & Regulatory meetings (continue membership with AAH Regulatory committee and Medicare Jurisdiction Councils) and report findings to management.
• Develop and maintain Reimbursement training programs in collaboration with other stakeholders.
• Manage all federal, state and commercial payor audits.
• Collaborate with the product development team in the area of coding, policy and funding of new products.
• Manage all new and renewals of payor credentialing.
• Adhere to Pledge of Confidentiality

• Information regarding a patient of this company shall not be released to any source outside of this Kestra Medical Technology Services, Inc. Reviewed 02.2025 Director of Public Healthcare & Payor Compliance company without the signed permission of the patient. Furthermore, information will only be released internally on a need-to-know basis. All Team Members will not discuss patient cases outside the office or with anyone not employed by this company unless they are directly involved with the patient’s case.

COMPETENCIES

• Passion: Contagious excitement about the company – sense of urgency. Commitment to continuous improvement.
• Integrity: Commitment, accountability, and dedication to the highest ethical standards.
• Collaboration/Teamwork: Inclusion of Team Member regardless of geography, position, and product or service.
• Action/Results: High energy, decisive planning, timely execution.
• Innovation: Generation of new ideas from original thinking.
• Customer Focus: Exceed customer expectations, quality of products, services, and experience always present of mind.
• Emotional Intelligence: Recognizes, understands, manages one’s own emotions and is able to influence others. A critical skill for pressure situations.
• Ability to be a self-starter, seek new and better methods, and work with minimum supervision.
• Demonstrates deep expertise in profession and industry best practices.
• Ability to collaborate within a Team environment and across functions.
• Capability to discern relevant facts and in turn, effectively resolve issues by making good decisions (compliance, quality, integrity, ethics, and critical thinking ability).
• Ability to be flexible in a fast-paced goal-oriented environment.
• Demonstrates the understanding of deadlines and time limits, ability to accomplish goals, and the desire to win.

EDUCATION/EXPERIENCE REQUIRED:

• Bachelors degree
• At least 15 years of experience in DME Reimbursement field – policy, funding & billing
• Advance knowledge/proficiency in government (Medicare/Medicaid) regulations and Commercial Insurance
• Contracts, as required.
• Strong background in financial management and knowledgeable of federal and state laws and requirements relating to healthcare/governmental regulations.
• Proficiency with Bonafide, Microsoft Office Word, Excel, and PowerPoint preferred

Preferred:

• Masters degree

WORK ENVIRONMENT

• Indoor open office environment
• Minimal noise volume typical to an office environment
• Extended hours when needed
• Kestra manufactures and provides life-saving products regulated by the Federal Food and Drug
• Administration and under contract with Medicare. Kestra maintains a drug free workplace and testing is a condition of employment post-offer.

PHYSICAL DEMANDS

• Frequent repetitive motions that may include wrists, hands and/or fingers, such as keyboard and mouse usage
• Frequent stationary position, often standing or sitting for prolonged periods of time
• Frequent computer use
• Frequent phone and other business machine use
• Occasional lifting required, up to 25 pounds

TRAVEL

• Occasional travel, domestic and international, may be required, less than 25%

OTHER DUTIES:

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the Team Member. Duties, responsibilities, and activities may change or new ones may be assigned at any time with or without notice.

Kestra offers a very competitive benefit package including Medical, Dental, 401K with Match, etc.

Pay equity is an important part of Kestra’s Culture. Our compensation ranges are guided by national and local salary surveys and take into consideration experience level and internal equity. Each role is benchmarked based on the job description provided If your qualifications and/or experience level are outside of the posted position, we encourage you to apply as we are growing fast and roles that are coming soon may not be posted.

Salary: Annualized at $185,000-$217,000, plus bonus. Depending on experience and location.

Kestra Medical Technologies is an equal opportunity employer. Kestra Medical Technologies does not discriminate on the basis of race, color, religion, national origin, veteran status, age, sexual orientation, gender identity and/or expression, marital status, disability, physical or mental status or any other characteristic protected by law.

We are unable to sponsor or take over sponsorship of employment visas at this time. Applicants must be eligible to work for any employer in the U.S.

Kestra manufactures and provides life-saving products regulated by the Federal Food and Drug Administration and under contract with Medicare.  Kestra maintains a drug free workplace and testing is a condition of employment.