Denials and Follow-up Supervisor - Saratoga Hospital : Job Details

Summary of Position: The Supervisor of Denials assumes direct and primary responsibility for the ongoing management of day to day Denials operations, including but not limited to; assumes direct responsibility of various denials and follow up roles; analysis and status of claims that are outstanding or denied by health insurance payers;#working with revenue cycle departments by responding to inquiries and working with payer representatives. #Developing effective relationships with all parties to contribute to overall success of Denials and Follow Up Management. Provides leadership on areas of improvement, recommendations and efficiencies to optimize revenue while creating a high functioning environment holding staff accountable while providing growth opportunities. An extensive working knowledge of payer#s denial and reimbursement policies, rules and appeal processes. Primary Job Duties: Leadership: Assumes direct and primary responsibility for guidance, support and monitoring performance of day to day tasks conducted by direct reports. Fostering strong teamwork and high-functioning work environment for PFS. Claim Denials: Handle and resolve all denied claims assigned on worklist through the work queue system. Works with revenue cycle departments to resolve denials. Identify root cause analysis of denied claims as assigned. Account Follow Up: Conducts research to assist with completing follow up processes and stays informed on best practices. Partners with PFS employees to continue promoting Denials engagement and quality improvement. Information Systems and Reporting: Effectively utilizes various assigned systems to submit and/or resolve claim issues. Complete assigned reports to follow up on aging receivables as assigned. Identifies improvement opportunities and contributes to the implementation of such improvements. Collaboration: Contributes and attends various committee and working group meetings. Prepares, maintains and works assigned denial reports to assist in the improvement of the aging receivables. Acts as primary liaison to provide guidance to other departments related to denial and follow up matters while developing effective relationships with all parties to contribute to overall success of PFS. Third Party Payer Relationship: Problem Solve issues with third party payer as assigned. Understand the rules and regulations of third party billing for the payers assigned. Knowledge of non-governmental contract components for payers assigned. Access Third Party Carriers direct portals through the internet for issues related to obtaining eligibility verification or verification of payment of services. Additional Responsibilities: Participate on various committees assigned for revenue cycle process improvement. Supervisory Responsibilities: Monitors employee performance on a daily basis and handles all initial oral or written disciplinary actions to staff; prepares performance evaluations annually for direct reports. Provides one on one feedback. Minimum Qualifications: Bachelor#s Degree required and 5 years of hospital/professional billing or insurance claim processing experience. Required Skills, Abilities, and Attributes: Knowledge of the billing standard- HIPAA 5010 version. Understand all components of a UB claim form for and a HCFA 1500 claim form.# I.e., Type of Bill (TOB), Rev Code, Place of service code (POS). Solid understanding of health care billing and reimbursement methodologies, as well as the information systems used by healthcare finance, billing and management care contracting and analysis Ability to organize and establish day-to-day priorities while utilizing critical thinking skills in all aspects of the job.# Must be able to multitask while remaining professional, focused, composed and positive. Must be able to establish an appropriate and effective rapport with others. Must be flexible to take initiative and embrace new opportunities to grow both personally and#organizationally. Problem solving skills. Proficient with various Microsoft Office products (Word and Excel). Strong organizational skills and effective interpersonal skills. Ability to work as part of a team and independently. Takes initiative and embraces new opportunities # Salary Range: $26.91 - $43.01 Pay Grade: 29 Compensation may vary based upon, but not limited to: overall experience and qualifications, shift, and location.

Summary of Position:

The Supervisor of Denials assumes direct and primary responsibility for the ongoing management of day to day Denials operations, including but not limited to; assumes direct responsibility of various denials and follow up roles; analysis and status of claims that are outstanding or denied by health insurance payers; working with revenue cycle departments by responding to inquiries and working with payer representatives. Developing effective relationships with all parties to contribute to overall success of Denials and Follow Up Management. Provides leadership on areas of improvement, recommendations and efficiencies to optimize revenue while creating a high functioning environment holding staff accountable while providing growth opportunities. An extensive working knowledge of payer's denial and reimbursement policies, rules and appeal processes.

Primary Job Duties:

* Leadership: Assumes direct and primary responsibility for guidance, support and monitoring performance of day to day tasks conducted by direct reports. Fostering strong teamwork and high-functioning work environment for PFS.

* Claim Denials: Handle and resolve all denied claims assigned on worklist through the work queue system. Works with revenue cycle departments to resolve denials. Identify root cause analysis of denied claims as assigned.

* Account Follow Up: Conducts research to assist with completing follow up processes and stays informed on best practices. Partners with PFS employees to continue promoting Denials engagement and quality improvement.

* Information Systems and Reporting: Effectively utilizes various assigned systems to submit and/or resolve claim issues. Complete assigned reports to follow up on aging receivables as assigned. Identifies improvement opportunities and contributes to the implementation of such improvements.

* Collaboration: Contributes and attends various committee and working group meetings. Prepares, maintains and works assigned denial reports to assist in the improvement of the aging receivables. Acts as primary liaison to provide guidance to other departments related to denial and follow up matters while developing effective relationships with all parties to contribute to overall success of PFS.

* Third Party Payer Relationship: Problem Solve issues with third party payer as assigned. Understand the rules and regulations of third party billing for the payers assigned. Knowledge of non-governmental contract components for payers assigned. Access Third Party Carriers direct portals through the internet for issues related to obtaining eligibility verification or verification of payment of services.

Additional Responsibilities:

Participate on various committees assigned for revenue cycle process improvement.

Supervisory Responsibilities:

Monitors employee performance on a daily basis and handles all initial oral or written disciplinary actions to staff; prepares performance evaluations annually for direct reports. Provides one on one feedback.

Minimum Qualifications:

Bachelor's Degree required and 5 years of hospital/professional billing or insurance claim processing experience.

Required Skills, Abilities, and Attributes:

* Knowledge of the billing standard- HIPAA 5010 version.

* Understand all components of a UB claim form for and a HCFA 1500 claim form. I.e., Type of Bill (TOB), Rev Code, Place of service code (POS).

* Solid understanding of health care billing and reimbursement methodologies, as well as the information systems used by healthcare finance, billing and management care contracting and analysis

* Ability to organize and establish day-to-day priorities while utilizing critical thinking skills in all aspects of the job.

* Must be able to multitask while remaining professional, focused, composed and positive.

* Must be able to establish an appropriate and effective rapport with others.

* Must be flexible to take initiative and embrace new opportunities to grow both personally and organizationally.

* Problem solving skills.

* Proficient with various Microsoft Office products (Word and Excel).

* Strong organizational skills and effective interpersonal skills.

* Ability to work as part of a team and independently.

* Takes initiative and embraces new opportunities

Salary Range: $26.91 - $43.01

Pay Grade: 29

Compensation may vary based upon, but not limited to: overall experience and qualifications, shift, and location.