Supervise workflow of collections team to ensure appropriate coverage within the department according to daily variants.
Maintain a relative balance of individual responsibility over various insurance aging regions and realign when necessary
Maintain staffing schedules to meet the needs of the business
Operate within established budget and make staffing recommendations as the needs of the business change.
Assist, resolve, and report any problems to management regarding the day-to-day operations in the department.
Maintain reports as assigned to monitor reimbursement metrics including, but not limited to: individual region and broader aging reports, daily Gimba Stats (percentage of AR “current”, daily activities of reimbursement team including denial actions, denial trends) write-offs, and bad debt.
Acts as resource within Reimbursement by responding to inquiries and technical issues regarding patient claims
Responsible for overseeing training of new employees and providing ongoing education of reimbursement and organization processes and procedures
Provides performance coaching and constructive performance feedback to Reimbursement team under the guidance of Senior Manager.
Processes and approves employee timesheets
Represents the department and interfaces with other departments as needed to respond to issues in absence of Senior Manager.
Drive, participate, and develop (when appropriate) payer / reimbursement strategic initiatives.
Drive, participate, and develop (when appropriate) process improvement initiatives.
Enforce corporate policies regarding account adjustments and write-offs
Maintain knowledge of systems and their capabilities. Identify and support implementation of ways to automate and streamline billing and reimbursement cycle processes by maximizing system utilization.
Ensure operational processes and use systems support accurate data collection that will provide meaningful management reporting tools for improving billing and reimbursement operations.
Ensure compliance with federal and state laws specifically pertaining to billing and reimbursement by analyzing internal policies and implementing appropriate changes.
Provide guidance and billing updates to departmental billing staff
Participate in and support a periodically scheduled billing and reimbursement external audit process to prevent internal control weaknesses and to ensure an independent and objective evaluation of the operation.
Responsible for ensuring that department understands and complies with quality standards and requirements as documented.
This job description reflects management’s assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.
Minimum 3 years’ experience managing in an insurance revenue cycle environment
Strong working knowledge of insurance revenue cycle including (but not limited to) how to read and interpret explanation of benefits, and basic insurance terminology, and common industry processes.
Excellent communication skills in interacting with internal contacts and outside third parties.
Billing experience in a complex setting as well as knowledge of the functions and use of billing systems strongly preferred.
Dedicated, passionate, and goal-oriented
Insurance law, CPT & ICD-9/ICD-10 coding, physician billing knowledge, and continuation education courses helpful.
