Actively manage all aspects of the Account Receivables Management to achieve and maintain adjudication goals set by senior management. This includes directing and supervising all staff within the department.
- Coordinate efforts of your assigned A/R follow-up team, independently and as a team with other departments, to achieve adjudication and other goals set for the department.
- Monitor ETM outcomes and hold staff members accountable to established targets and thresholds
- Direct work efforts of staff members
- Coordinate with offshore management to effectively work all tasks allocated to them and resolve any issues affecting reimbursement and/or adjudication
- General A/R management and upstream reporting on health of A/R
- Manage to defined goals
- Develop reporting to proactively monitor A/R to identify and resolve issues affecting reimbursement and/or adjudication
- Monitor, understand and communicate to Director trends by state/payor/facility, including but not limited to:
* No Activity
* Adjudication time
* Review aging by state/facility/payor
- Development and implementation of initiatives, including interaction with billing support department and IT
- Project oversight and management, including interaction with billing support and IT
- Provide a communication bridge to other departments to resolve issues that arise with provider enrollment, demographic quality, claim forms etc.
- Work with the Quality Assurance Department to develop methods of monitoring the quality of the offshore work performed. Monitor results and take corrective actions as necessary
- Provide leadership development for the client representatives in managing their workflow and overall health of department A/R. Monitor each representative’s performance daily to provide frequent and constructive feedback to keep them on the right track.
- Manage the administrative aspects of the department, including but not limited to:
- Development of policies and procedures for department
- Maintenance of working files
- Acquisition and maintenance of the tools and supplied required by the department
- Manage all personnel aspects of the department, including
- Maintenance of adequate staffing levels
- Performance reviews done on time
- Counseling sessions and disciplinary write-ups
- Maintaining open lines of communication to assure personnel issues are being handled in a timely and appropriate manner
- Participate in various committees as required
- Participate in problem resolution at all levels
- Be a role model within the department by exhibiting mature leadership qualities such as a positive outlook, confidentiality, respect, and team spirit.
- Attend meetings as required
- Assure that HIPAA compliance guidelines are followed
- All other duties as assigned
- Minimum of three years experience managing employees
- Minimum of three years experience in Part B claims adjudication, including but not limited to:
- Explanation of Benefit forms (EOB)
- Credit balances (discounts and refunds)
- Insurance carrier billing requirements
- Provider enrollment
- Strong analytical and problem solving skills.
- Strong desktop PC skills in Excel
- Ability to work well in a team environment
- Professional attitude and demeanor
- Strong working knowledge of the GE Centricity Business system (aka Flowcast) and coordinating modules, is preferred
- Must be extremely detail oriented and organized, a self–starter capable of tracking to deadlines and meeting goals.
- Ability to work autonomously and as a team member, with little supervision required once a goal is assigned.
- Excellent verbal, written, and interpersonal communications skills.
- May require sitting for long periods of time; also stooping, bending, and reaching for files and supplies.
- Requires manual dexterity sufficient to operate a computer keyboard, answer a telephone, run a copier and other office equipment as necessary.
- Vision must be correctable to 20/20.
- 2 years ago - save job