JOB DESCRIPTION OVERVIEW:
Supervise Denials Resolution Department at Billing Center and remote staff. Manage daily workflow and ensures the department meets or exceeds standards for quality, production, and performance. The Supervisor ensures assigned employees are trained and consistently follow all Team Health policies and procedures including applicable HIPPAA and Compliance Polices.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Directs processing of and monitors the resolution of claim denials
- Analyzes system data and denial reports and makes recommendations to Manager on process improvements.
- Evaluates carrier requirements and formulates a denials resolution strategy.
- Consults with AR Manager to prioritize the working of denials and maintains current denials to meet Team Health Standards.
- Supervises Denials Resolution Representatives in working denials including productivity and quality of work
- Monitors work of team members, maintains effective personnel relations and ensures that goals are achieved
- Compiles and communicates issues for management intervention and works on issue resolution)
- Identifies issues with existing processes and initiates process improvement
- Works with other denials supervisors to improve denials resolution processes across Billing Centers
- Manages department within budget guidelines
- Performs other duties and assignments as requested by the Accounts Receivable Manager or Director of AR
- Assists with research and development of appropriate denial procedures
- Creates and maintains policies consistent with HCFS and Team Health policies
- Updates and submits for approval policies and procedures for department
- Understands Team Health compliance plan and HIPPA regulations. Informs appropriate Manager(s), Director(s), VP(s) or Corporate when obvious inappropriate business practices are evident that may affect not only reimbursement and accounts receivable management, but also relationships with clients, hospitals, payers and legal status. This includes any noted compliance or HIPPA concerns.
Job Requirements:
QUALIFICATIONS / EXPERIENCE:
- High school diploma or equivalent
- Knowledge of healthcare payer reimbursement for physician billing
- Knowledge of ICD-9 and CPT-4 coding
- Prior Denials Resolution experience preferred
- Minimum of three years as a Senior/Lead and preferable five years total physician-billing experience; with specifically two years’ experience in Denials and Appeals or A/R Management.
- Computer proficient; intermediate Excel skills required
- Good oral/written communication and interpersonal skills required
- Good analytical, follow-up and organizational skills required
- Proficiency in working with billing systems (IDX experience is desirable
SUPERVISORY RESPONSIBILITIES:
- Manages Denials Resolution Senior
PHYSICAL / ENVIRONMENTAL DEMANDS:
- Job performed in a well-lighted, modern office setting
- Occasional standing/bending
- Occasional lifting/carrying (20lbs or less)
- Moderate stress
- Prolonged sitting
- Prolonged work on a PC/computer
- Prolonged telephone work
- Occasional travel may be required.
This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.
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