Supervisor, Healthcare Billing Recovery Operations

Performant • Plantation, FL

9d • $60,000 - $70,000 • Remote

About The Position

We are looking for a highly-skilled, talented Healthcare Billing Recovery Operations Supervisor that drives results and leads by example leveraging expertise in Medical Billing Recovery, knowledge of Coordination of Benefits and Third Party Liability (COB/TPL), Medicare Secondary Payer (MSP) claims involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) and procedural challenges regulations; experience generating or auditing medical bills; proven ability to interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues; and communicate effectively with liable parties to recapture payments. Ability to train and guide Billing Recovery Case Specialists, handle escalated calls and cases; and support management with compliance, quality, program operation functions such as Insurer/Plan outreach or case inventory assignments, and continuous improvement efforts. Also performs supervisory functions, coaches employees for development, provides constructive feedback and disciplinary actions in conjunction with the applicable operational manager. Key Responsibilities As the Healthcare Billing Recovery Operations Supervisor, you will be responsible for Specialists (caseworkers) performing billing and recovery services to/for Group Health Plans, Non-Group Health Plans, and other related, authorized, and liable parties. Ensure staffing and training of case specialists for assigned business. Contribute to development and continuous improvement of operational tools, processes and procedures. Ensure assigned team consistently achieves established metrics and goals assigned, quality and compliance requirements. Leads by example and demonstrates Performant core values in performance of job duties and all interactions. Provides feedback, coaching and additional training to assigned team to correct areas of deficiency and oversight received from quality reviews and/or management, as well as performance feedback and skills development to increase capability and effectiveness of specialists. Oversee work activities and provide guidance for case and call escalation to specialists including, but not limited to: Review account claim and other documentation to verify payment liability for claims paid in error. Make outbound calls to contact liable parties regarding payment of claims; answer questions and educate liable parties on their obligation to pay. Effectively follow scripts, guidelines and other tools provided to have professional conversations with liable party contacts. Review documentation and claim billing, build the case file to determine/validate liability, evaluate and respond to defenses refuting payment liability, status the account and initiate appropriate letter correspondence, answer questions and/or provide information that will bring to successful payment or other appropriate account action. Initiate applicable action and documentation based upon payment option, actions required if new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay. Update company systems with clear and accurate information Initiates activity based upon arrangement with liable parties; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures. Escalates accounts for Nurse Case Worker review as appropriate for complex claims. Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims. Ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations. May be required to work some Performant holidays due to client requirement. Perform other incidental and related duties as assigned to meet business needs.

Requirements

• Demonstrated ability to lead and drive operational results in similar healthcare billing recovery or insurance claim review function.
• Leverages operational reports and data to evaluate team results and identify areas for improvement.
• Develops approaches and initiates action to improve and grow employee skills and team results.
• Demonstrated ability to inspire and lead a team of operational staff; knowledge of best practices to successfully hire, train, coach, motivate, develop, manage performance, and hold accountability of team members.
• Knowledge and experience with medical claim billing procedures, medical terminology, and medical coding, preferably in a role generating, auditing, recovery and/or researching the same involving Worker’s Compensation, Auto Liability, and other non-group health plan primary payer liabilities.
• Experience with Coordination of Benefits and Medicare Secondary Payer involving Group Health Plan (GHP) and Non-Group Health Plan (NGHP) Third Parties.
• Proven expertise in gather and interpret Explanation of Benefits (EOB) to answer questions and resolve medical billing issues, including Medicare and Medicaid claims.
• Ability to communicate professionally and effectively with management, staff, client and vendor representatives, providers, carriers, beneficiaries and other audiences regarding claims and billing payment.
• Protects patients’ privacy, understands, and adheres to HIPAA standards and regulations.
• Remarkable interpersonal and communication skills; ability to listen, be succinct and demonstrate positive customer service and servant leadership attitude.
• Ability to share knowledge and educate staff and third parties on healthcare billing and claims related terminology, procedures, and related information.
• Self-motivated and thrives in a fast-paced office environment performing multiple tasks cohesively, with keen attention to detail.
• Proficiency using standard office technology; computer, various applications and navigation of on-line tools and resources, keyboard, mouse, phone, headset.
• Ability to apply knowledge learned in training from various forms (memos, classroom training, on-line training, meetings, discussions, etc.).
• Ability to follow, teach, and support improvement of process, procedures, and workflow.
• Ability to effectively perform deliver results, and work cooperatively with others to promote a positive team environment.
• Ability to adapt quickly and transition effectively to changing circumstances, client requirements, assignments, and business needs.
• Ability to consistently perform job responsibilities.
• Possess a personality type that is ethical, friendly, hard-working, and proactive.
• Minimum 2 years of experience as a supervisor, or lead with supervisory responsibilities, for similar function.
• Minimum 5 years of experience in medical billing experience demonstrating depth of knowledge and capability required for the position.
• Minimum 3 years of experience in customer service, billing reclamation or recovery, or call center role demonstrating application of similar skills preferably in a healthcare or related industry.
• High School diploma or GED required.

Nice To Haves

• Some college in medical terminology, billing, coding, or Medical Billing/Coding certification preferred.

Responsibilities

• Responsible for Specialists (caseworkers) performing billing and recovery services to/for Group Health Plans, Non-Group Health Plans, and other related, authorized, and liable parties.
• Ensure staffing and training of case specialists for assigned business.
• Contribute to development and continuous improvement of operational tools, processes and procedures.
• Ensure assigned team consistently achieves established metrics and goals assigned, quality and compliance requirements.
• Leads by example and demonstrates Performant core values in performance of job duties and all interactions.
• Provides feedback, coaching and additional training to assigned team to correct areas of deficiency and oversight received from quality reviews and/or management, as well as performance feedback and skills development to increase capability and effectiveness of specialists.
• Oversee work activities and provide guidance for case and call escalation to specialists including, but not limited to: Review account claim and other documentation to verify payment liability for claims paid in error.
• Make outbound calls to contact liable parties regarding payment of claims; answer questions and educate liable parties on their obligation to pay.
• Effectively follow scripts, guidelines and other tools provided to have professional conversations with liable party contacts.
• Review documentation and claim billing, build the case file to determine/validate liability, evaluate and respond to defenses refuting payment liability, status the account and initiate appropriate letter correspondence, answer questions and/or provide information that will bring to successful payment or other appropriate account action.
• Initiate applicable action and documentation based upon payment option, actions required if new information is identified that may change the obligation to pay, or escalation in the event of refusal to pay.
• Update company systems with clear and accurate information
• Initiates activity based upon arrangement with liable parties; follows-up and follows through accordingly to ensure documentation and activity is on-time and accurate in accordance with policies and procedures.
• Escalates accounts for Nurse Case Worker review as appropriate for complex claims.
• Support internal groups or functions with interpretation of EOB (explanation of benefits), as well as development of knowledge base and understanding of key concepts and terminology in healthcare billing and claims.
• Ensure compliance with client requirements, HIPAA, as well as applicable federal or state regulations.
• May be required to work some Performant holidays due to client requirement.
• Perform other incidental and related duties as assigned to meet business needs.

Benefits

• Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED