Professional Billing & Follow-Up/Denials Supervisor

Cape Cod Healthcare•Hyannis, MA

About The Position

Oversee day-to-day operations of the Billing and Follow Up teams to ensure professional (PB) claims are worked timely and accurately. This position will work under the supervision of the Manager of Professional Billing AR Resolution. Collaborate with Revenue Cycle teams to ensure complaint and accurate billing of claims, facilitating problem resolution of billing issues. Define, implement, and monitor strategies to improve billing and accounts receivable management processes. Oversee performance and productivity measures of the team as it relates to, AR follow-up, denials management, underpayment recoupment and credit balance resolution. Consistently complete performance monitoring processes and implements corrective actions as required. Monitor, analyze and report key revenue cycle metrics to ensure the team is aligned with CCHC leadership and the MGMA Key Performance Indicators such as Days in A/R, Aged A/R, Denial rates, etc. Define and implement action plans when performance is not meeting expectations. 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. 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. Evaluate and implement opportunities for workflow automation and optimization. Partner with CCHC IT analysts to leverage technology and improve efficiency. Utilize technology and reporting to identify trends, risks, opportunities and root cause to implement corrective strategies. Support implementation of changes needed to address payer contract changes and payer/regulatory requirement changes and to improve overall processing efficiency. Confirm that all control processes are effectively minimizing denial appeal related timely filing denials. Collaborate with other disciplines to implement changes needed to address payer contract changes and regulatory requirement changes. Maintain positive relationships with; attends monthly meetings with key payers to discuss reimbursement issues and payor publication notices affecting claims processing and account follow-up. Support work needed for external audits. Support and assist in department functions/responsibilities as needed based upon volume and workload. 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.

Requirements

Minimum two years’ experience required in healthcare revenue cycle methodologies.
Experience and knowledge of professional billing/registration systems.
Experience and knowledge of regulatory requirements, payer requirements and 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.

Nice To Haves

Bachelor's degree related to Business Administration or Healthcare preferred.
Supervisory experience in healthcare environment preferred.

Responsibilities

Oversee day-to-day operations of the Billing and Follow Up teams to ensure professional (PB) claims are worked timely and accurately.
Collaborate with Revenue Cycle teams to ensure complaint and accurate billing of claims, facilitating problem resolution of billing issues.
Define, implement, and monitor strategies to improve billing and accounts receivable management processes.
Oversee performance and productivity measures of the team as it relates to, AR follow-up, denials management, underpayment recoupment and credit balance resolution.
Consistently complete performance monitoring processes and implements corrective actions as required.
Monitor, analyze and report key revenue cycle metrics to ensure the team is aligned with CCHC leadership and the MGMA Key Performance Indicators such as Days in A/R, Aged A/R, Denial rates, etc.
Define and implement action plans when performance is not meeting expectations.
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.
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.
Evaluate and implement opportunities for workflow automation and optimization.
Partner with CCHC IT analysts to leverage technology and improve efficiency.
Utilize technology and reporting to identify trends, risks, opportunities and root cause to implement corrective strategies.
Support implementation of changes needed to address payer contract changes and payer/regulatory requirement changes and to improve overall processing efficiency.
Confirm that all control processes are effectively minimizing denial appeal related timely filing denials.
Collaborate with other disciplines to implement changes needed to address payer contract changes and regulatory requirement changes.
Maintain positive relationships with; attends monthly meetings with key payers to discuss reimbursement issues and payor publication notices affecting claims processing and account follow-up.
Support work needed for external audits.
Support and assist in department functions/responsibilities as needed based upon volume and workload.
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.