Job Description

The AR Medical Payment Specialist Supervisor is responsible for researching outstanding balances and determining correct action to be taken to ensure maximum reimbursement. Must take the lead on corrective actions for accounts with outstanding balances in a timely manner to obtain reimbursement. Responsible for processing correspondence relating to the financial status of an account. Responsible for recognizing trends for denials and reimbursement issues and reporting such to the Accounts Receivable & Collection Manager. Monitors Billing Staff performance and productivity and meets with Accounts Receivable & Collection Manager regarding updates on appropriate utilization and quality assurance.

Work is typically performed in an office environment, but this position may have the option to work from home. The specific statements for this job description are not intended to be all inclusive. They represent typical elements considered necessary to successfully perform the job.

REPORTING RELATIONSHIPS

The position reports to the Accounts Receivable & Collection Manager. Staff that are dedicated Medical Payment and Accounts Receivable report to this position.

ESSENTIAL JOB DUTIES and FUNCTIONS

While living and demonstrating our Core Values, the AR Medical Payment Specialist Supervisor will:

• Manage outstanding accounts receivable. Resolve outstanding balances, resubmitting claims and providing necessary information to support prompt payment. Parties which may be contacted to resolve an outstanding balance include but are not limited to patients, responsible parties, insurance carriers, case managers, employers, referring physician, attorneys and facility personnel
• Follow up on outstanding accounts receivable, focusing on maintaining aged receivables within 60 days of days outstanding. Includes researching aged account reports, outstanding “to-do” list, and processing problematic EOB’s
• Make all necessary corrections in the billing system. Research and resolve claims rejected by payer. Decide if accounts can’t be paid by the insurance company and summarize for review with the VP Controller Revenue cycle.
• Identify billing and coverage concerns. Communicate with billing and front office staff regarding billing requirements not being met
• Answer patient and facility questions about account balance and status of payment. Decide if patient balance is refusal to pay or inability to pay, so the account can be added to a fee waiver request by the VP Controller Revenue Cycle)
• Responsible for triaging workload and prioritizing tasks through proper utilization of staff resources
• Identify, correct and communicate facility errors to appropriate parties involved and produce corrective action plans accordingly
• Identify and communicate payment trends to the Accounts Receivable & Collections Manager, related to payers, CPT codes, diagnosis codes, etc.
• Identify, correct and communicate payment posting errors to staff
• Research outstanding credit balances and prepare/approve requests for refunds
• Research and recommend/approve accounts for bad debt write off
• Along with departmental managers, develop a strategy the team will use to reach goals and maintain high level of productivity
• Provide training that team members may need and monitor progress
• Create reports to update the organization on Billing Department progress
• Develops policies and procedures regarding all front-end revenue cycle processes including insurances, copay collection, payment plans, Sliding Fee, Outreach and Enrollment
• Develop trainings to ensure proper co-pay collection at the level of the front desk. Further, partner with operational leadership to develop co-pay collection accountability
• Periodically, prepares and presents progress reports to the Executive Team, Board of Directors and Staff
• Works closely with the credentialing team to ensure targets are met for providers to meet timely filing and reduce the rate of claim rejections
• Meets with payor representatives and is knowledgeable of contractual agreements with regards to reimbursement models

Requirements

QUALIFICATIONS

• High school degree or equivalent with knowledge of health care project management OR equivalent combination of education and experience
• 6-10 years’ of medical billing/claims experience
• Experience in CPT codes and ICD 9 and/or ICD 10 coding preferred
• Detail oriented and timely delivery of projects
• Experience with electronic medical records
• FQHC multi-specialty billing and coding experience preferred
• Experience in Excel and Word preferred