About the position
The Patient Access and EDI Supervisor oversees the demographic data capture, eligibility and insurance verification, and EDI processes. This leadership role is critical in optimizing revenue cycle processes, ensuring compliance, and improving overall operational efficiency. This role will ensure the smooth and accurate exchange of electronic healthcare data, including claims, remittances, eligibility inquiries, and other transactions between our organization and external stakeholders such as insurance payers, healthcare providers, clearinghouses and vendors. The ideal candidate will have extensive experience in revenue cycle management within healthcare, with a strong focus on electronic data interchange and eligibility verification processes, a data driven mindset leveraging technology to identify trends and a proven track record of process improvement.
Responsibilities
- Direct and manage the eligibility and insurance verification and EDI teams, ensuring alignment with organizational goals and objectives
- Demonstrate leadership through cooperative interactions such as problem-solving, excellent written/verbal communication, and customer focus
- Present as a role model for conflict management and resolution
- Maintain personal contact with subordinates to ensure understanding of all assignments
- Ensure adequate staffing and equipment needs for the responsible business units
- Ensure staff is cross trained to provide backup and relief
- Provide leadership support to other areas as needed
- Continuously evaluate and improve processes, develop and implement best practices to enhance efficiency, accuracy and compliance
- Work closely with IT and business teams to implement solutions that align with revenue cycle goals and healthcare regulations (e.g., HIPAA, ANSI X12 standards)
- Oversee the daily operations of eligibility verification processes to ensure timely and accurate determination of patient insurance coverage
- Monitor translation of hospital data capture to ensure accurate claim delivery for timely adjudication in accordance with payor guidelines
- Oversee, in conjunction with external partners, the vetting, cross-walking and/or correcting of automated electronic demographic data and accurate posting of non-automated records
- Oversee the daily operations of EDI workflows related to electronic and paper claim submissions, remittance advice, eligibility verification, electronic funds transfers and other revenue cycle processes
- Ensure all EDI transactions are transmitted accurately and in a timely manner between the organization and external parties, including payers, clearinghouses, and providers
- Understand and document appropriate Network and File Transfer operations
- Monitor and manage EDI transaction volumes, identifying and resolving any transaction errors, failures, or delays
- Troubleshoot EDI issues, collaborating with internal teams (e.g., IT, billing, coding) and external partners to resolve data discrepancies
- Ensure that all EDI transactions are compliant with relevant regulatory requirements, including HIPAA and payer-specific guidelines
- Stay updated on industry changes, new EDI standards (e.g., ICD-10, ANSI X12 updates), and payer-specific requirements to ensure continued compliance and system compatibility
- Oversee patient registration processes to ensure accurate and complete demographic data was captured at the time-of-service entry
- Monitor and resolve discrepancies in patient demographic data, ensuring the accuracy and integrity of all records
- Collaborate with cross-functional teams to ensure accurate data flow from patient registration to billing and EDI processes
- Identify opportunities for improving data capture processes, reducing errors, and enhancing overall data quality
- Ensure demographic data updates are timely and consistent with patient eligibility and insurance verification
- Establish key performance indicators (KPIs) to monitor departmental performance, identify areas for improvement, and drive accountability
- Assist with the design of quality measures for each major process establishment or change
- Monitor adherence to Service Level Agreements
- Develop and maintain reports and dashboards to track key performance indicators (KPIs) such as claim rejection rates, denial rates, claim processing times, and successful transactions
- Analyze trends in claim rejections and denials to identify root causes and recommend corrective actions
- Provide regular updates to senior management regarding performance and opportunities for improvement
- Work closely with cross functional departments, including IT, HIE, Reimbursement Coding, Payment Posting, AR, Banking, Client Services, Finance, and Executive Management to ensure seamless coordination of revenue cycle activities
- Mentor and train staff to enhance their skills and knowledge in revenue cycle processes, compliance, and best practices.
- Ensure all activities comply with federal and state regulations, as well as payer requirements.
- In conjunction with the Executive Director, recruit and select personnel to fill positions within the departments
- Provide orientation, training and mentoring to staff in accordance with company standards
- Communicate, monitor and evaluate goals and expectations for departmental performance
- Oversee timekeeping and other human resource related duties as required
- Discipline staff (coaching, verbal and written warning, suspension, and termination as indicated)
- Complete annual performance evaluations for staff within prescribed time
Requirements
- Bachelor’s degree in Healthcare Administration, Business Administration, or a related field; or equivalent experience in healthcare revenue cycle
- Minimum of 4 years of experience in revenue cycle management, with at least 2 years in a leadership role, preferably within revenue cycle management or hospital setting
- Strong knowledge of eligibility and insurance verification processes, provider enrollment, and EDI practices
- Proven track record of process improvement and operational excellence in revenue cycle
- Familiarity with healthcare regulations, compliance standards, and payer requirements is essential.
- Knowledge of current federal, state, and insurance payor regulations
- Excellent analytical and problem-solving skills, with the ability to interpret complex data and make informed decisions
- Exceptional communication and interpersonal skills, with the ability to collaborate effectively with cross-functional teams and stakeholders
- Intimately familiar with network and File Transfer operations
- Extensive knowledge of EDI standards (e.g., ANSI X12) and healthcare transaction types (claims, remittances, eligibility, etc.)
- Detail oriented with the ability to prioritize work, meet established priority timelines and maintain confidentiality
- Proficient in revenue cycle management software and Microsoft Office Suite.
- Athena IDX or GE Centricity experience a plus
Benefits
- Remote work will require a home office setup. Internet and cellular connectivity will be required.
