Supervisor, Out of State Medicaid

EnableComp • Franklin, TN

12d

About The Position

The Supervisor, OSM is a critical support role that oversees a team of Revenue Specialists and Account Managers and serves as the internal escalation point for claim processing resolution. This role also supports the overall success of our client’s accounts by managing and responding to client inquiries, engaging document management processes for the purpose of processing claims as well as payment research, invoice/billing inquiries, file delays, system access, and other relevant items.

Requirements

• High School Diploma or GED required. Associates or Bachelor’s Degree a plus.
• 5 years’ experience in healthcare field working in billing or collections.
• 5 years’ client facing/customer services experience.
• 1-2 years supervisory or team lead experience.
• 3-5 years’ experience with workers compensation billing and collections preferred.
• Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Equivalent combination of education and experience will be considered.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
• Regular and predictable attendance.

Responsibilities

• Responsible for the daily supervision of assigned Revenue Services teams.
• Serves as the primary escalation point, to directly or through staff, work with clients to resolve roadblocks that may hinder the claims resolution process and provides direction to Account Managers and Revenue Specialists to resolve existing claims/ client issues.
• Partners with Managers to disseminate priority of daily tasks to assigned team.
• Prepares performances evaluations and account reviews and plays a role in delivering both documents in conjunction with the Department Leader.
• Analyze and evaluate claim payments using EnableComp’s proprietary software, systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable state worker’s compensation fee schedule and/or PPO contract.
• Research, request and acquire all pertinent medical records, implant manufacturer’s invoices and any other supporting documentation necessary and then submit with hospital claims to insurance companies to ensure prompt correct claims reimbursement.
• Manage internal coordination, communication, and messaging for external client requests and reported issues.
• Create, review, and maintain external-facing client reports.
• Facilitate internal and external meetings to discuss process improvements, resolve client issues, and/or resolve internal issues.
• Respond and communicate with external clients regarding topics such as: remote system access, document requests, payment research requests, coordination of end-user training, and others.
• Conduct timely and thorough telephone follow-up with insurance companies to ensure proper reimbursement.
• Prepare correct initial bill packet or appeal letter using EnableComp systems tools.
• Works with Data Analytics team to research issues with claim and payment imports, etc.
• Trains and mentors staff as needed including new hires, especially in regards to ongoing training needs that may result from the SOP for goal escalation.
• Works with Data Quality team to research issues with calculations and other projects.
• Works with Document Management team to remove roadblocks around document acquisition and other requisite items needed to collect accounts.
• Perform Quality Control tasks on behalf of management regarding account flow and due diligence.
• Usually works more difficult clients.
• Responsible for the full employee life cycle including hiring decisions, training, performance management, and corrective action.
• Handle patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.
• Support operational initiatives through team collaboration.
• Other duties as required.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees