JOB DESCRIPTION OVERVIEW :
Supervise the Denials Resolution Department at the Billing Center. 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 the processing of and monitors the resolution of claim denials. Analyzes system data and denial reports and makes recommendations to the Managers to improve processes. Evaluates carrier requirements and formulates a denials resolution strategy. Consults with AR Manager to prioritize the working of denials and maintains current denials and appeals to meet Team Health Standards. Supervises Denials and Appeals 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 the denials resolution processes across Billing Centers Manages department within budget guidelines. Processes RAC Audit requests Reviews specific edits listed on the Unbilled Charges Report Reviews and analyzes specific rejection codes listed on the Denied Invoices Pending Report Other duties as assigned 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. QUALIFICATIONS / EXPERIENCE: Excellent knowledge of healthcare payer reimbursement for physician billing Prior experience in managing denials resolution. Good communication and interpersonal skills Knowledge of ICD-9 and CPT-4 coding Good team management skills Good analytical skills Good knowledge of Excel Proficiency in working with systems (IDX experience is desirable) Computer literate Excellent follow-up skills Excellent organizational skills EDUCATION: High School diploma or equivalent required EXPERIENCE: At least (3) 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. WORKING CONDITIONS: General office environment This position may be relatively highly stressful with significant workload. Set in a high-volume, fast-paced office environment. Involves extensive computer use. Mandatory overtime as directed by Management. TRAVEL: Occasional travel to seminar or training sessions may be required. SUPERVISORY RESPONSIBILITIES: Manages EMC/NEIC Representative(s) PHYSICAL / ENVIRONMENTAL DEMANDS: Job performed in a well-lighted, modern office setting. Occasional standing/bending Occasional lifting/carrying (20lbs or less) Some travel locally and overnight Moderate stress Prolonged sitting Prolonged work on a PC/computer Prolonged telephone work
