The Revenue Cycle Systems Supervisor is responsible for supervising the daily operations in the following areas: Medical Claims Processing / Third Party Administrator (TPA), Cash Posting Data Entry, and Patient Accounting systems along with processing Client Data Corrections. Provides training and cross training to staff to ensure policy and procedures are adhered to. Responsible for trending and preparing weekly/monthly trend analysis dashboards and working closely with management and subsidiaries in providing feedback, recommendations and education when applicable ensuring errors are at a minimal.
- High School Diploma required with Bachelor’s degree preferred
- Minimum five (5) years of medical billing and collection experience with two years spent training and coaching experience preferred
- Minimum one year technical experience in healthcare industry preferred
- Knowledge in Crystal Reports
- Experience in System Administrator functions for third party payors preferred
- Knowledge of Hospice state and federal billing regulations required
- Knowledge of Third Party Administrator (TPA) claims processing preferred
- Advanced computer skills with Microsoft Office knowledge preferred
- Ability to create and present reports to review and identify possible trends while encouraging process improvements
- Strong analytical and problem-solving skills require
- Knowledge of medical terminology preferred
- Excellent verbal and written communication skills to multiple levels
- Ability to take initiative, prioritize and multi-task independently with minimal supervision
- Valid driver’s license and automobile insurance per Company policy Competencies:
- Satisfactorily complete competency requirements for this position.Responsibilities of all employees:
- Represent the Company professionally at all times through care delivered and/or services provided to all clients.
- Comply with all state, federal and local government regulations, maintaining a strong position against fraud and abuse.
- Comply with Company policies, procedures and standard practices.
- Observe Company health, safety and security practices.
- Promote the Company through participation in community and professional organizations.
- Participate proactively in improving performance at the organizational, departmental and individual levels.
- Improve own professional knowledge and skill level.
- Advance electronic media skills.
- Support Company research and educational activities.
- Share expertise with co-workers both formally and informally.
- Participate in Quality Assessment Performance Improvement activities as appropriate for the position.Job Responsibilities:Leadership
- Responsible for managing PTO requests and work schedules of those supervised.
- Provide training, mentoring, constructive, actionable, detailed feedback for staff.
- Prepare reports to monitor production flows.
- Meet with new hires monthly during initial 90-day probationary period to ensure new hire check list is utilized and training needs and tools are being provided to ensure a successful 90-day completion.
- Prepare and provide annual employee evaluations alongside manager.
- Provide input and assist manager with employee coaching, process improvement and disciplinary plans.
- Responsible for special projects and all other duties as appropriate under supervision of individuals direct Manager and/or Director.
Client Data Correction Processing
- Provide expertise and consultation in answering questions to team members and outside departments regarding policy, regulation, procedures, and documentation processes.
- Process Client Data Correction request according to set departmental standards.
- Create a Track-It Work Order Ticket and follow up with requestor to either resolve or close the Client Data Correction request.
- Create weekly/monthly dashboard trend analysis of Client Data Corrections processed.
- Produce and maintain report for pending Client Data Corrections to adjust billing as required.
- Communicate and validate process changes are adhered to as directed by management.
- Responsible for monitoring Client Data Correction work orders to ensure they are worked timely and appropriately.
- Review and escalate when applicable, Service Client by Location report data discrepancies and Multiple Level of Care Report ensuring accounts are resolved and EMR corrected by request from Clinical Manager.
- Provide input on Client Data Correction process improvement projects and assist with testing and quality assurance.
- Assist in team coverage when necessary to ensure no disruption in work flows occur in the absence of team member(s).
- Attend and actively participates in departmental meetings.
- Meet departmental productivity and quality assurance standards in accordance with departmental policies.
- Responsible for special projects and all other duties as assigned.
- Promptly answer support related email, phone calls and other electronic communications.
· Mentor, train and develop staff, making necessary staffing recommendations to ensure third party medical claims are processed in an accurate and timely manner.
· Assist staff in resolving issues concerning invoices and vendor communications.
· Lead/drive or participate in initiatives in the Medical Claims Processing area that will yield improvements in the timeliness and accuracy of claims processes.
- Ensure open communication and cooperation is maintained between Claims Process staff, outside vendors to include TPA, clinical staff and General Accounting.
· Perform random monthly quality assurance (QA) on claims processed in-house and by TPA.
· Produce weekly/monthly trending reports on claims volume in regards to payments, denials, second level approvals, appeals and other applicable key indicators.
- Conduct root cause analysis when data integrity and payment issues are discovered.
Revenue Cycle Systems
- Provide System Administrative duties for the following vendors but not limited to; Solutions, Emdeon, Medicare DDE, Medicaid and Third Party Payors.
- Coordinate submission, tracking and resolution of Patient Account’s system related issues with Solutions.
- Monitor Emdeon Dashboard to identify areas of opportunity to increase claim submission validation rate.
- Coordinate submission, tracking and resolution of Emdeon 24/7 system tickets to ensure timely billing resolution.
- Demonstrate the ability to reconcile payments and contractuals when reviewing accounts in order to ensure the accuracy of the account balance.
- Advise his/her manager of any, payer cash fluctuation trends, denials or vendor Part B claims processed by Accounts Payable or Third Party Administrator, to ensure proper handling and escalation as necessary.
- Assist in cash posting, downloading Electronic Remittance Advice (ERA) for systematic cash posting to patient accounts, scanning of processed Examination of Benefits (EOB) and balancing daily by utilizing daily cash log provided by Finance.
- Assist Keying 81A “Notice of Election” for Patient Accounting department.
- Process appropriate Physician Part B charges to Part A claims for billing in accordance to departmental standard operating procedure.
- Assist in sending monthly patient invoices, as needed.Other
- Perform other duties as assigned.