Supervisor Denials and Follow Up- Hybrid Job at St. Elizabeth HealthCare
Job Description
This position supports the Manager of Denials & Follow-Up in daily operational issues including monitoring the quality, productivity, denial metrics, accounts receivable, claim audit volumes (RAC and non-governmental), and supporting all staff within the unit. The individual assists with identifying payor denial trends and deficient areas internally. This person identifies appropriate information pertaining to denials & audits that is to be submitted to departments to ensure systems, processes and measures of effectiveness (e.g. Remediation action plans) are created and implemented to resolve root cause issues and reduce/ eliminate denials. Position is also responsible for management of the department in the absence of the Manager. Assist with system evaluation, testing, implementations, upgrades, and software changes. Perform troubleshooting, auditing, system integration(s), and coordination with Information Systems personnel (IS), Revenue Enhancement, Patient Access Departments, Hospice, etc. Provides technical support and training to users as needed and assist management team with system related issues. Responsibilities include staying current on Commercial, other third party, and Government regulations. In addition, training all department staff in regard to follow-up functions, denial, & audit functions and acting as liaison between denials/follow-up staff and other units and/or departments. Work closely with the hospital billing supervisor to achieve the most cohesive billing and clearing-house systems. Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.
Job Duties
Supervisor & HR Responsibilities
A. Manage and coach a subordinate group.
B. Performs employee performance evaluations and participates in employee performance evaluations by giving the Manager of Denials and Follow-Up information gathered from account reviews and observations.
C. Develop, promote and maintain professional relationships, both internally and externally.
D. Train develop and coach, counsel, assign duties and work schedules. Evaluate job performance and review performance appraisal with personnel. Initiate or recommend necessary counseling, disciplinary actions, termination and commendatory actions.
E. Communicates with Manager and payers of any issues that would prohibit claim payment and elevate serious barriers to appropriate management.
F. Provide effective leadership to ensure goals of the department and the organization.
G. Demonstrates adequate, appropriate, and professional levels of communication with insurance company representatives, team members, managers and directors.
H. Assists other associates, when necessary, as determined by the manager, works with staff to identify and resolve issues to develop standard practices.
I. Completes special projects and tasks by the established time frame, which can include organizing workload and/or associates for successful account resolution: proactively notifies manager of any barriers that prohibit billing and/or payment of claims.
J. Assumes duties of manager as needed. Assists co-worker(s) in problem solving, with reports, work lists, meetings, etc.
K. Serves as a backup in the absence of staff members.
L. Assign monitor/review the task progress and ensure accurate work of a group of employees.
M. Inform management of overall performance of team members.
N. Provide technical guidance on more complex issues, including but limited to, maximum reimbursement.
O. Provide instruction so others on the team can complete tasks quickly and effectively.
Team Coordination
A. Create and maintain procedures for the department.
B. Assists the leadership team with the identification and resolution of follow-up, denial, recoupment, and/or billing issues.
C. Reviews and works with Manger, Follow Up Lead, and Denials Lead weekly in follow-up issues, denial issues, and/or associate issues.
D. Execute training of contracted staff (internal and external).
E. Maintain collaborative working relationships with HIM, clinical, financial and support departments and Third-Party Payers to coordinate and facilitate the unit activities, to accomplish goals and objectives and to resolve problems.
Qualifications
MINIMUM
Education, Credentials, Licenses:
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This position supports the Manager of Denials & Follow-Up in daily operational issues including monitoring the quality, productivity, denial metrics, accounts receivable, claim audit volumes (RAC and non-governmental), and supporting all staff within the unit. The individual assists with identifying payor denial trends and deficient areas internally. This person identifies appropriate information pertaining to denials & audits that is to be submitted to departments to ensure systems, processes and measures of effectiveness (e.g. Remediation action plans) are created and implemented to resolve root cause issues and reduce/ eliminate denials. Position is also responsible for management of the department in the absence of the Manager. Assist with system evaluation, testing, implementations, upgrades, and software changes. Perform troubleshooting, auditing, system integration(s), and coordination with Information Systems personnel (IS), Revenue Enhancement, Patient Access Departments, Hospice, etc. Provides technical support and training to users as needed and assist management team with system related issues. Responsibilities include staying current on Commercial, other third party, and Government regulations. In addition, training all department staff in regard to follow-up functions, denial, & audit functions and acting as liaison between denials/follow-up staff and other units and/or departments. Work closely with the hospital billing supervisor to achieve the most cohesive billing and clearing-house systems. Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.
Job Duties
Supervisor & HR Responsibilities
A. Manage and coach a subordinate group.
B. Performs employee performance evaluations and participates in employee performance evaluations by giving the Manager of Denials and Follow-Up information gathered from account reviews and observations.
C. Develop, promote and maintain professional relationships, both internally and externally.
D. Train develop and coach, counsel, assign duties and work schedules. Evaluate job performance and review performance appraisal with personnel. Initiate or recommend necessary counseling, disciplinary actions, termination and commendatory actions.
E. Communicates with Manager and payers of any issues that would prohibit claim payment and elevate serious barriers to appropriate management.
F. Provide effective leadership to ensure goals of the department and the organization.
G. Demonstrates adequate, appropriate, and professional levels of communication with insurance company representatives, team members, managers and directors.
H. Assists other associates, when necessary, as determined by the manager, works with staff to identify and resolve issues to develop standard practices.
I. Completes special projects and tasks by the established time frame, which can include organizing workload and/or associates for successful account resolution: proactively notifies manager of any barriers that prohibit billing and/or payment of claims.
J. Assumes duties of manager as needed. Assists co-worker(s) in problem solving, with reports, work lists, meetings, etc.
K. Serves as a backup in the absence of staff members.
L. Assign monitor/review the task progress and ensure accurate work of a group of employees.
M. Inform management of overall performance of team members.
N. Provide technical guidance on more complex issues, including but limited to, maximum reimbursement.
O. Provide instruction so others on the team can complete tasks quickly and effectively.
Team Coordination
A. Create and maintain procedures for the department.
B. Assists the leadership team with the identification and resolution of follow-up, denial, recoupment, and/or billing issues.
C. Reviews and works with Manger, Follow Up Lead, and Denials Lead weekly in follow-up issues, denial issues, and/or associate issues.
D. Execute training of contracted staff (internal and external).
E. Maintain collaborative working relationships with HIM, clinical, financial and support departments and Third-Party Payers to coordinate and facilitate the unit activities, to accomplish goals and objectives and to resolve problems.
Qualifications
MINIMUM
Education, Credentials, Licenses:
- Associates degree in a related field including clinical or business
- Knowledge of regulations for Commercial, Government and other Third-Party insurance
- Knowledge of Medicare/Medicaid regulations and related governmental regulations including RAC and Governmental Audits
- PC Microsoft Windows Applications
- Excellent communication skills - verbal and written
- 3 - 5 years of related experience including: Commercial, Government and other Third-Party hospital billing / follow-up / denial / audit / reimbursement / collection experience.
Please Note :
clarksqn.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, clarksqn.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.