Executes on established department objectives and assignments which affect the immediate operation, but that also have full revenue cycle, and company-wide fiscal impact.
Monitor all staff worklists and unit email inboxes to ensure turnaround time, aging, and dollar thresholds for all unit worklists are being maintained to achieve established targets.
Maintain all team lead worklists at inflow, escalating issues as appropriate to supervisor.
Work with management team to utilize various aging, reconciliation, credit, and worklist reports to realign staff priorities to achieve unit goals.
Monitor staff productivity and perform weekly quality reviews, identifying issues, and providing training to improve statistics.
Participate with supervisor in QR delivery.
Ensuring that staff meets the productivity goal standard of 95% or higher while maintaining an average quality score of 2.80 or above.
Ensure availability to staff to provide support in resolving escalated payor inquiries, and patient complaints within required timeframes.
Answers day-to-day work-related questions related to policies and procedures, systems, and processes, assisting team members in problem solving.
Promoting enhanced quality and the reduction of unnecessary redundancies among staff.
Collaborating with unit Leadership and various departments within the revenue cycle to ensure the prompt resolution of escalations and customer disputes.
Engaging with staff and leadership on assigned projects as necessary.
Assisting in the training of new employees and developing training materials as needed.
Approving refunds and adjustments within a specified dollar threshold.
Required Knowledge and Experience:
Good to Have:
Experience leading a team or project and working as a subject matter expert. Demonstrated ability to prioritize work, handling daily and multiple tasks to completion within the time allotted.
Ability to prepare forms, spreadsheets, and graphs.
Experience with reading, and understanding medical policy information, and utilizing insurance benefit and coverage information to calculate estimated patient responsibility, taking into consideration pre-determination, referral, authorization, and contract terms.
Experience with various insurance plans offered by both government and commercial insurances (i.e., PPO, HMO, EPO, POS, Medicare, Medicaid, HRA s) and coordination of healthcare benefits, including requirements for referral, authorization, and pre-determination.
Experience with medical billing and collections terminology - CPT, HCPCS and ICD-9 coding.
Experience with HIPAA guidelines and healthcare compliance.
Previous experience in receiving and making outbound calls to patients to explain insurance benefits related to health insurance, and/or discussing patient financial responsibilities.
Proficiency in navigating multiple screens and MS Office Suite
