Supervises employees engaged in customer service, clerical support, insurance billing, collections, cash application, and/or refunds to TMC HealthCare patients. Ensures that documentation is accurate, financial information is verified, and provides information to appropriate personnel in a timely manner.
Performs supervisory functions; prepares work schedules, assigns staff, observes and reviews performance to provide input to formal evaluations, and makes recommendations for personnel actions; assists in staff selection and provides orientation, training and ongoing in-services for staff. Works with payor representatives on complex, problematic accounts troubleshooting and identifying trends in payor claim denials or complex issues.
Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff. Adheres to and supports staff in exhibiting TMCH values of integrity, community, compassion, and dedication. Demonstrates and upholds established standards of behavior, safety, and confidentiality, as well as TMCH and department policies and standards.
Ensures compliance with all applicable regulatory requirements. Provides input for budget preparation and monitors/controls expenses within approved budget allocations. Collects accounts not paid in full at time of discharge or promised date; recommends use of collection agencies or legal services for delinquent accounts.
Answers all inquiries regarding accounts. Prepares reports reflecting status of billing, credit and collection activities. Supervises policy and procedures relating to credit and collections; assumes responsibility for all accounts within one or more financial classes.
Evaluates agency performance and recommends changes as required. Resolves complaints/concerns within TMC HealthCare guidelines and patient satisfaction. Monitors reconciliation of daily cash and posted payments to accounts receivable.
Evaluates procedures to improve methods for controlling payor and patient account receivables. Oversees refunds and contractual write-offs. Maintains department records, reports, and files as required.
Reviews reports related to generated edits and aging accounts receivable. Maintains and manages the credit balance report within the department’s established guidelines. Evaluates pre bad debt reports and makes recommendations to management.
Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards. Performs related duties as assigned.
Associates Degree (A. A.) or equivalent from an accredited two-year college or technical school, or an equivalent combination of relevant education and experience on a year-for-year basis.
Four (4) years related medical billing, insurance, customer service or scheduling experience, preferably in a lead or supervisory role. LICENSURE OR CERTIFICATION : None required. KNOWLEDGE, SKILLS AND ABILITIES : Knowledge of electronic billing and any necessary systems related to Patient Accounting.
Knowledge of codes related to patient billing including revenue codes, and all diagnostic related codes. Knowledge of medical insurance practices and policies and regulations. Knowledge of government and non government uniform billing guidelines.
Knowledge of medical terminology and coding. Skill in evaluating claims and itemized statements in order to collect in a timely manner. Skill in evaluating employees and processes and providing recommendations for improvement.
Skill in leading and training staff. Proficient in use of Excel, Word, Internet, email, and financial software programs and network systems. Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
Ability to write reports, business correspondence and procedure manuals. Ability to effectively present information and respond to inquiries or complaints from employees, patients, and/or their representatives, and the general public. Ability to calculate figures and compute rate, ratio, and percent and to draw and interpret bar graphs and apply basic algebraic concepts.
Ability to apply common sense understanding to carry out detailed written or oral instructions. Ability to solve problems involving complex variables in standardized situations.