Billing and Collections Supervisor, RMF Denials Management

FLSA STATUS: Non-Exempt MISSION STATEMENT: Our Mission is to improve the well-being of those we serve with a commitment to excellence: every patient, every encounter, every time. VISION: Our Vision is to create a world-class health system to advance medicine and increase access for the communities we serve by empowering caregivers to heal through compassion, knowledge, innovation, integrated care and excellence.

• The Billing & Collections Supervisor is responsible for ensuring that the DHR Health Denials Resolution and Management specialists effectively review and address denied patient insurance claims. This role involves managing the timely review and response to insurance company correspondence related to claim denials. The supervisor also oversees that appeal letters are well prepared, containing all necessary information and supporting documentation to effectively challenge denials. Additionally, the supervisor is accountable for maintaining high-quality standards, ensuring adherence to processes, and meeting departmental metrics and goals. The Billing & Collections Supervisor is instrumental in overseeing the quality of reports, monitoring and analyzing trends, and identifying areas for improvement. This role is crucial for creating educational opportunities within the Revenue Cycle departments. POSITION EDUCATION/ QUALIFICATIONS­:
• High School Diploma/GED: Required
• College

• Preferred
• Healthcare Reimbursement Knowledge: Comprehensive understanding of healthcare reimbursement processes. Medical Terminology: Proficient in medical terminology.
• EOBs and RAs: Familiarity with Explanation of Benefits (EOBs) and Remittance Advices (RAs).
• Microsoft Office Suite: Knowledge of Microsoft Office, with a strong working knowledge of Excel required.
• Customer Service: Excellent customer service skills.
• Communication

• Strong written and verbal communication skills.
• Multi-tasking: Ability to manage multiple tasks efficiently.
• Language Proficiency: Ability to read, write, and speak English.
• Management Communication: Capable of communicating clearly and concisely with all levels of management.
• Bilingual: English/Spanish is preferred. JOB KNOWLEDGE/EXPERIENCE­:
• Healthcare

Minimum of 5 years of healthcare experience required, with hospital experience preferred. • Management

Previous management experience is preferred. • Communication

• Ability to communicate clearly and concisely, working effectively with employees, patients, and external parties.
• Denials Management Meetings: Attendance and participation in denials management meetings.
• Microsoft Office Proficiency: Demonstrates proficiency in Microsoft Office applications, with typing speed of at least 35 WPM and strong working knowledge of Excel.
• Mathematical and Written

• Ability to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, and spell correctly.
• Medical Coding Knowledge: Familiarity with medical terminology, ICD-9, ICD-10 codes, CPT codes, HCPCS codes, and modifiers.
• Information Retrieval: Ability to use the internet to obtain information from third-party payers or other sources.
• Focus and Judgment: Capable of working with minimal to moderate interruptions, exercising good judgment, and demonstrating strong reasoning abilities.
• Stress Management: Ability to handle pressure, meet deadlines, and remain productive in challenging situations.

The Billing & Collections Supervisor is responsible for performing the following duties and overseeing the daily activities of the Denials Resolution and Management specialists: Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices Review and Resolution: Ensure that specialists effectively review and resolve denied patient insurance claims.

Correspondence Management: Oversee the timely review and response to insurance company communications regarding claim denials. Appeal Letter Oversight: Ensure that appeal letters are accurately prepared, including all necessary information and supporting documentation to successfully overturn denials. Quality Monitoring: Maintain high standards of quality by monitoring the processes and performance of the team.

Quality Improvement Support: Assist in identifying, drafting, implementing, and monitoring quality improvement action plans. Metric Achievement: Ensure that departmental metrics and goals are met through effective management and oversight. Trend Analysis: Monitor and analyze trends to identify areas for improvement.

Educational Development: Facilitate the creation of educational opportunities within the Revenue Cycle departments to enhance performance and knowledge.· Compliance Notification: Notify the Senior Director of any compliance concerns or incidents promptly.· Patient Confidentiality: Ensure that patient confidentiality requirements are upheld in compliance with HIPAA policies and procedures· Educational Conference Calls: Participate in educational conference calls.· Cross Training and Familiarization: Engage in, cross-train and become familiar with both professional and facility denials.

Additional Duties: Perform other tasks as required for the project. HealthStream Learning Modules: Complete HealthStream learning modules in a timely manner. Other information: LINES OF REPSONSIBILITIES: (Chain-of-command) 1.

Senior Director → 2. Chief Executive Officer CUSTOMER SERVICE: Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.

A. R. E.

S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service. AGE SPECIFIC: Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret the appropriate information needed to identify each patient’s requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA): A.

Indicated by bold print within performance standards, preceding individual numbered criteria. The following table provides physical requirements that will be associated with, but not limited to, this position: Light/moderate lifting up to 20 lbs, from the floor to shoulder height. Yes Kneeling Yes Must be able to assist other employees with lifting more than 20 lbs.

Yes Walking Yes Light/moderate carrying up to 20 lbs. Yes Standing/Squatting Yes Straight pulling Yes Sitting Yes Pulling hand over hand Yes Pushing Yes Repeated bending Yes Stooping/Bending Yes Reaching above shoulder Yes Climbing Stairs Yes Simple grasping Yes Climbing Ladders No Dual simultaneous grasping Yes Depth Perceptions needed Yes Ability to see Yes Identify Colors Yes Operating office equipment Yes Twisting Yes Operating mechanical equipment Yes Crawling No Ability to read and write Yes Ability to Count Yes Ability to hear verbal communication without aid Yes Operating Personal Vehicle Yes Ability to comprehend written/verbal communication Yes Other: Ability to deal with stress Yes OSHA Category III B.

Working Conditions: The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents.

C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment to perform or assist in emergency medical care or first aid or to be potentially exposed in some other way.

D. Aptitudes: HIGH 1 2 3 4 5 6 LOW Intelligence: General learning ability: The ability to “catch on” or understand instructions and underlying principles. Ability to reason and make judgments. 3 Verbal: Ability to understand meanings of words and ideas associated with them, and to use them effectively.

To comprehend language, to understand relationships between words, and to understand meanings of whole sentences and paragraphs. To present information or ideas clearly. 3 Numerical: Ability to perform arithmetic operations quickly and accurately. 2 Spatial: Ability to comprehend forms in space and understands relationships of plane and solid objects. Frequently described as the ability to “visualize” objects or two or three dimensions, or to think visually of geometric forms. 2 Form Perception: Ability to perceive pertinent details and objects or in pictorial or graphic material to make visual comparisons and discriminations and see slight differences in shapes and shadings of figures and widths and lengths of lines. 3 Clerical Perception: Ability to receive pertinent details and verbal or tabular material.

To observe differences in copy, to proofread words and numbers, and to avoid perceptual errors in arithmetic computation. 2 Motor Coordination: Ability to coordinate eyes and hands to fingers rapidly and accurately in making precise movements with speed. Ability to make a movement response accurately and quickly. 3 Finger Dexterity: Ability to move hands easily and skillfully. To work with fingers in placing and turning motions. 3 Manual Dexterity: Ability to move hands easily and skillfully.

To work with hands in placing and turning motions. 3 Eye-Hand-Foot Coordination: Ability to move the hand and foot coordinately with each other in accordance with visual stimuli. 3 Color Discrimination: Ability to perceive and respond to similarities or differences in colors, shapes, or other values of the same or different color. To identify a particular color, or to recognize harmonious or contrasting color combinations, or to match color adequately. 3