Job Abstract

In addition to the responsibilities listed below, this position may also be responsible for using advanced knowledge to enforce solutions used by others to process and resolve rejections and denials from insurance payers to ensure service costs are charged; and identifying trends, identifying the root cause of issues, and resolving complex workflow or build issues; using comprehensive knowledge to overseeing and coaching the researching, coping, and mailing member-financial records to the respective requestor (e.g., court, attorney, copy services) while recommending and implementing process improvements; overseeing timely quality reviews and audits and provides education and coaching of staff for the verification and validation of insurance coverage discovery, coordination of benefits, applying insurance to a patient account; coaching of staff of patient account to ensure appropriate coverage; resolving coverage-related errors or disputes; partnering, facilitating with vendors to ensure the coverage for underinsured and self-pay patients is completed in a timely manner while resolving delays in coverage; overseeing timely review and provide education and coaching to drive and improve processes for obtaining third party, workers compensation, and secondary coverage payments; using advanced knowledge of the field and critical information from other diverse areas to define programs, quality and productivity standards, coaching the team to negotiate payment plans to set terms of pay agreement, explaining what is owed, offering discounts, and resolve escalations and define prevention; using advanced knowledge of business practices to coach the team to providing customer service while explaining the application process, providing direction to the team to processing applications and disposition, follow policy regulations and provide MFA status, provide quality assurance and ensuring quality standards are being met; assuring alignment with government guidelines and internal policies; resolve escalations; participates in policy review and recommendation for awarding or denying decisions of MFA committee; managing performance to ensure the team efficiently collects cost-share at time of service or post-service collections based on system deposit, schedule, and collect payments; monitoring closure of cash drawers when needed; ensuring accountability for adherence and enforcing SOX regulations and conducting remediations; issuing complex solutions that require ingenuity, and are used by others to demands for payment of services provided; recommending and sharing new strategies and processes for continuous account monitoring, predicting bad debt exposure, proactive risk analysis, payment terms analysis and overpayment management; overseeing the enrollment of providers in Medicare, Medicaid, and workers compensation; using advanced knowledge of the payment practices and critical information from other diverse areas to recommend and implement solutions; ensuring adherence and enforcing SOX regulations; oversees payment posting operations, while collaborating with Accounting, Treasury, IT and banks to effectively remediate complex payment posting issues; managing the team to ensure resolution of the processing of credit cards and refunds by the staff are completed according to statutory timelines; assisting with research on simple and complex refund inquiries; approval of refund authority within FDA; responding to CMS requests; oversees the timeframes and completion of processing bankruptcy, deceased, court decrees, and triage ROI requests in partnership with other groups; removing barriers, escalating issues, recommending improvements, providing advanced knowledge for statement redesigns, and partnering across teams to resolve issues.

• Provides developmental opportunities for others; builds collaborative, cross-functional relationships. Solicits and acts on performance feedback; works closely with employees to set goals and provide open feedback and coaching to drive performance improvement. Pursues professional growth; develops and provides training and development to talent for growth opportunities; supports execution of performance management guidelines and expectations. Leads, adapts, implements, and stays up to date with organizational change, challenges, feedback, best practices, processes, and industry trends. Fosters open dialogue amongst team members, engages, motivates, and promotes collaboration within and across teams. Delegates tasks and decisions as appropriate; provides appropriate support, guidance, and scope; encourages development and consideration of options in decision making.
• Manages designated work unit or team by translating business plans into tactical action items; oversees the completion of work assignments and identifies opportunities for improvement; ensures all policies and procedures are followed. Aligns team efforts; builds accountability for and measuring progress in achieving results; determines and ensures processes and methodologies are implemented; resolves escalated issues as appropriate; sets standards and measures progress. Fosters the development of work plans to meet business priorities and deadlines; obtains and distributes resources. Removes obstacles that impact performance; identifies and addresses improvement opportunities; guides performance and develops contingency plans accordingly; influences teams to execute in alignment with operational objectives.
• Ensures the teams work is in compliance by: overseeing and monitoring the teams work to ensure they adhere to federal and state laws, and applicable compliance standards, and creating the monthly quality reports to leadership, and escalating unresolved issues to senior management.
• Ensures accurate patient accounts by: overseeing the management of inquires from providers, members, attorneys, and other insurance personnel to answer a complex billing questions and evaluating new systems.
• Manages the denial process by: leading the teams quality of performance affecting complex denials and ensuring effective remediation and overseeing the teams data analysis and partnership efforts when making recommendations while also performing follow-up and denial management activities related to the collections of outstanding self-pay and/or insurance balances while also recommending accounts and performs necessary outreach to guarantors, insurance companies and attorneys to ensure timely, accurate payments.
• Ensures finances are completed accurately by: working within allocated budget for the assigned area by monitoring usage and ensuring proper use of expenditures.
• Manages performance management initiatives by: monitoring the teams performance and providing coaching to ensure the teams work meets established performance levels and analyzes financial data and create complex solutions that require ingenuity, and are used by others to generate reports for relevant departments and medical centers to assess performance progress. uses advances knowledge to ensures quality to oversee performance to enable decision making by providing feedback and driving the implementation of strategies to ensure vendor performance of collections, coding services, systems, coverage validation, income verification also reviewing and validating invoices.
• Manages process management initiatives by: using advanced knowledge of the technical and operational fields and critical information from other diverse areas to conduct root-cause analysis and plan process improvement projects and identify business needs with operations managers, IT, clinicians, and health plan managers while also implementing, complex planning to translate business needs into project requirements that are then used to develop project specifications and action plans.
• Manages project management initiatives by: leads project execution and management efforts by managing team members to collaborate with stakeholders across functions to ensure the project is successfully executed and project-based changes are implemented.
• Leads regulatory reporting by: researching and applying regulation standards to recommend policy updates, managing regulatory extracts while also reviewing the accuracy of the teams work and providing feedback and implementing required changes.
• Facilitates with vendor relationships by: maintaining and managing relationship with vendors by working with senior internal and external contacts to manage execution of work in accordance with organizational guidelines and applying advanced knowledge to institute new regional procedures, guidelines, strategies, and methods for managing vendor relationships.
• Manages systems management initiatives by: collecting feedback, providing training, communication, and facilitating the review, validation of the build, preview and comment on adoption of new systems updates for the team, and escalates complex issues to senior management.
• Facilitates training delivery by: facilitating and delivering training, recommending training priorities, and recommend training delivery methods based on policies, audit findings, and work curriculum.
• Manages the training development process by: using advanced knowledge of the field and critical information from other diverse areas to identify education and training requirements that reflect revenue cycle changes to review new strategic training content.