Supervisor, Insurance Billing - Mercyhealth

Overview:

• Patient Accounts Supervisor, Insurance Billing Follow Up, Days, 80 Hrs/2wks
• Location: Rockton Ave Campus; Rockford, IL and MercyCare Bldg; Janesville, WI. Hybrid work opportunities. 

Supervises and coordinates activities of partners within the system-wide Follow-up Representative work group of Patient Financial Services. Manage and Supervise the Patient Financial Services Follow-up Department, directly supervise, recruit, hire, orient, discipline, develop and evaluate Financial Services staff. Responsible for ensuring claims are resolved with third party payers in a reasonable time frame as defined by Revenue Cycle metrics. This includes claims that fail payer rejection edits in order to resolve errors and submit corrected claims to payors. Develops a process to assess errors in order to quickly and effectively locate information to solve identified issues and see claims to a resolution. Collaborates with all related work groups and supervisors to coordinate work flows and processes needed to correct errors or improve efficiency process for optimal claim resolution and/or payment. Remains up-to-date on regulatory requirements through informal and formal updates, including self-study of payer bulletins and guidelines. Responsible for application of all Mercyhealth System policies. Performs other duties as assigned.

Responsibilities:

• Strong leadership, management, judgment, and presentation skills
• Knowledge of organizational policies and procedures.
• In-depth knowledge of all applications used by Patient Financial Services partners such as: Epic, Vispa, ArcProtect, Real Time Eligibility, Mercyhealth intranet, Microsoft Outlook, Kronos, Halogen, OnBase, etc.
• Responsible for maintaining budgeted staffing levels.
• Interviews and hires applicants.
• Travels to staff locations to serve as support to team members.
• Supervises partners and identifies areas of opportunity to help enhance partner development.
• Performs audits to review partner performance on an ongoing basis to ensure policies and procedures are being followed consistently and that any issues are brought to the attention of the Director.
• Evaluates partners by conducting employee reviews on time.
• Presents and discusses with partners in a timely manner pertinent findings and recommendations to their work performance.
• When deficiencies are noted, monitors employee performance through continued auditing to help identify if performance improvement plans or corrective action is necessary.
• Tracks and measures volume of work assigned to the partners to set goals and monitor trends and shifts in volume.
• Escalates changes in data and trends to the Director and/or Manager.
• Monitors and maintains productivity on each partner.
• Coordinates functions within defined work group, works cooperatively with other work group supervisors to ensure smooth and timely processing of third party claims and timely follow-upon receivables.
• Designs, revises, develops, and recommends policies and procedures for their respective work group and for the department to ensure workflows are consistently following Patient Financial Services standards. Implements finalized policies and procedures within the Revenue Cycle area.
• Coordinates with Managed Care Contracting for various third party payers to maintain and enhance appropriate claims processing procedures and ensures managed care contract terms are operationalized in the process.
• Reviews for approval any submitted adjustments, identifying partner and/or payor trends to help with any ongoing team education.
• Responsible for reviewing and analyzing new government billing regulations/guidelines, new managed care contract summaries, and industry publications to advise Director, partners, and other department heads of potential issues that could impact billing, reimbursement and compliance.
• Performs ongoing daily assessment of workflows, to ensure the most optimal path for claim reimbursement is in place, developing a process improvement where challenges present to help improve any financial outcomes.
• Maintains open communication with extensions of Mercyhealth billing partners, (extended business offices) when applicable, to assure pertinent information has been shared and any areas of opportunity has been resolved.

Education and Experience:

High school diploma or equivalent required. Associates degree in a business or healthcare field preferred. Five years of healthcare experience required, with emphasis in billing, insurance, collections, registration, scheduling, or customer service.

Certification/Licensure:

Epic Resolute certification(s) or billing certifications (AAPC CPB, HFMA CRCR, or comparable certification) required within one year.

Special Physicial Demands:

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is frequently required to sit. The employee is occasionally required to stand; walk; climb; or balance and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus.

 

Culture of Excellence Behavior Expectations: