Follow-up & Denials Supervisor - Cape Cod Healthcare : Job Details

1. Support, oversee, and manage the performance and productivity of the team as it relates to AR follow-up, denials, underpayment recoupment and credit balance resolution.

2. Define, implement and monitor strategies to improve accounts receivable management processes.

3. Support development of reporting processes.

4. Maintain up-to-date knowledge of regulatory and compliance changes impacting area of responsibility and ensures employees are appropriately educated and processes are modified as needed.

5. Oversee performance monitoring processes and implements corrective actions as required.

6. Ensure employees and vendor staff who are performing functions are doing it in a manner which complies with established policies, processes and quality assurance programs and addresses areas of non-compliance.

7. Support implementation of changes needed to address payer contract changes and payer/regulatory requirement changes and to improve overall processing efficiency.

8. Confirm that all control processes are effectively minimizing denial appeal related timely filing denials.

9. Collaborate with other disciplines to implement changes needed to address payer contract changes and regulatory requirement changes.

10. Maintain up-to-date knowledge of regulatory and compliance changes impacting operations, and ensures employees are appropriately educated and processes are modified as needed.

11. Manage to applicable Key Performance Indicators ( KPIs ). Define and implement action plans when performance is not meeting expectations.

12. Assess workflow prioritization on a daily basis to confirm that AR metrics and benchmarks are consistently achieved.

13. Maintain positive relationships with third-party or government payers; attends monthly meetings with key third-party or government payers to discuss reimbursement issues and payor publication notices affecting claims processing and account follow-up.

14. Support work needed for external audits and third-party reviews.

15. Support and assist in department functions/responsibilities as needed based upon volume and workload.

16. Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization's culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.

* Bachelor's degree related to Business Administration or Healthcare preferred

* Minimum two years' experience required in Billing Revenue Cycle Methodologies.

* Supervisory experience in healthcare environment preferred.

* Experience and knowledge of hospital billing/registration systems.

* Experience and knowledge of regulatory requirements, payer requirements and third party or government payer reimbursement.

* Excellent communication and interpersonal skills.

* Ability to evaluate personal performance against established goals.

* Ability to coach and support staff in their efforts to improve overall performance.

* Ability to communicate with a wide variety of CCHC and external users, including senior management and physicians, as well as outside vendors and consultants.

* Capable of learning reporting systems and other new tools.

* Exceptional time management skills.