Supervisor Insurance Follow-up

Supervises all staff and functions for insurance denials management and follow up within patient financial services office. Serves as the overall insurance billing expert and point of escalation to include supervising follow-up specialist staff and processes to resolve unpaid denied or incorrectly paid insurance claims including necessary refunds. Supervises workflows for insurance follow-up staff research payer issues that result in denials and presents findings for payer trends to PFS leadership.

SCHEDULE : Monday-Friday 8a-4 : 30p

MAJOR RESPONSIBILITIES & DUTIES :

Facilitates and provides direct oversight to Insurance Follow-Up Specialists serving as the groups liaison with other billing office groups as well as departments and leaders outside of PFS as it relates to insurance billing denials aged A / R rejections credits and underpayments.

Accountable for providing ample orientation and ongoing training of Insurance Follow-Up Specialists.

Continuously monitors follow-up specialists staffs workloads and assignments to ensure no A / R is unassigned and that staff assignments are set-up in such a way to avoid all timely filing and appeals adjustments at or below set performance standards as set forth by the Patient Financial Services Director.

Performs monthly audits of personnels productivity and ensures quality at the departments defined standards. Compiles audit results and findings tracks and trends each staffs ongoing results and communicates findings to management while coaching and mentoring staff when below standard results and trends exist.

Tracks trends analyzes and implements changes to fix / reduce payer denials and rejections. This includes using system and workflow updates education of staff and work with payer representatives and management to achieve goals (quarterly and annual) within the patient financial services office focusing on effectiveness and efficiency.

Maintains current knowledge of various payer specific contracts and policies as they relate to denials and rejections as well as ensuring staff is kept abreast of pertinent payer information allowing the staff to ensure the organization is being reimbursed correctly while having the ability to make sound business decisions based on the current payer contract information.

Assists in related system design build validation and training specific to contract management and communicates information necessary for follow up / appeal if the payer response received is incorrect.

Runs validates and distributes insurance follow up denials rejections performance and production to staff and management on set schedules.

Maintains supervision of insurance credit balances ensuring the staff works the credit balances within the compliance guidelines of Boys Town.

Actively fosters excellent teamwork to assist in achieving the mission while offering assistance to solving complex problems while responding effectively to crisis and unplanned events in a timely and confidential manner.

Oversees the interviewing selection evaluation of performance and coaching of Insurance Follow-Up Specialists.

Manages direct reports timecards on a weekly basis minimizing overtime situations and consulting employees of discrepancies when identified.

Communicates appropriately using good interpersonal skills ensuring that a positive professional demeanor is projected through verbal and non-verbal communications ensuring information for patients is delivered in a manner that is supportive timely and adjustment requests for completion and accuracy from insurance follow-up specialists approves and routes adjustments correctly within the appropriate approval and turnaround time guidelines as determined by the PFS Director.

KNOWLEDGE SKILLS AND ABILITIES :

Communicate professionally clearly and concisely both orally and in writing with all staff physicians and patients in all aspects of the job to allow for high levels of efficiency and promptness for patient care.

Function independently and with limited supervision.

Knowledge in UB92 HCFA 1500 Hospital Insurance Claims forms and their requirements which includes in depth knowledge of the most current version of ANSI 837 electronic claims files loops and segments along with understanding of CPT HCPCS ICD10 as related to denials and payments.

Knowledge in claims clearinghouse capabilities and related build and set up.

Problem solve and to apply exceptional analytical skills to creatively resolve issues and organize workload according to established priorities.

Strong attention to detail goal oriented and confidence in making independent decisions.

Knowledge of denials and their effect on revenue cycle operations.

Knowledge of Microsoft PC applications such as Outlook Word and Excel.

Serve as a positive role model for the billing office and to support the mission of Boys Town.

REQUIRED QUALIFICATIONS :

High school diploma or equivalent required.

Minimum of 5 years experience in healthcare and / or behavioral health related to claims and denials required.

Extensive experience in healthcare and / or behavioral health billing reimbursement issues and rules and regulations for insurance payers is required.

Previous lead or supervisory experience required.

Other Duties : This job description incorporates the essential functions and duties required for this position. However other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization.

Serves as a role model in carrying out activities and behaviors that reflect the values and principles of the Boys Town mission.

PHYSICAL REQUIREMENTS EQUIPMENT USAGE WORK ENVIRONMENT :

Requires sitting for long periods of time working in office environment. Occasionally lifting files or boxes weighing up to 30 pounds. Requires manual dexterity sufficient to operate a keyboard calculator copier fax machine telephone and other office equipment when necessary. Vision must be correctable to 20 / 20 and hearing must be normal range for telephone contacts. It is necessary to view and type on computer screen for long periods and to work in an environment which can be very stressful. The worker is not substantially exposed to adverse environmental conditions such as in typical office or administrative work. Work performed in an office environment involves frequent contact with staff patients and the public. Work may be stressful at times.

Care and respect for others is more than a commitment at Boys Town it is the foundation of who we are and what we do.

At Boys Town we cultivate a culture of belonging for all employees that respects their individual strengths views and experiences. We believe that our differences enable us to be a better team one that makes better decisions drives innovation and delivers better business results.

About Boys Town :

Boys Town has been changing the way America cares for children and families since 1917. With over a century of service our employees have helped us grow from a small boardinghouse in downtown Omaha Nebraska into one of the largest national child and family care organizations in the country. With the addition of Boys Town National Research Hospital in 1977 our services branched out into the health care and research fields offering even more career opportunities to those looking to make a real difference.

Our employees are our #1 supporters when it comes to achieving Boys Towns mission which is why we are proud of their commitment to making the world a better place for children families patients and communities . A unique feature for employees and their dependents enrolled in medical benefits are reduced to no cost visits for services performed by a Boys Town provider at a Boys Town location. Additional costs savings for the employee and their dependents are found in our pharmacy benefits with low to zero-dollar co-pays on certain maintenance drugs. Boys Town takes your mental health seriously with no cost mental health visits to an in-network provider. We help our employees prepare for retirement with a generous match on their 401K or 401K Roth account. Additional benefits include tuition assistance parenting resources from our experts and professional development opportunities within the organization just to name a few. Working at Boys Town is more than just a job it is a way of life.

This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties skills or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race color religion sex sexual orientation gender identity and / or expression national origin age disability or veteran status. To request a disability-related accommodation in the application process contact us at 1-.

Required Experience :

Manager

Key Skills

Sales Experience,Time Management,Marketing,Customer Service,Communication skills,Retail Sales,Business Management,Outside Sales,Telemarketing,Insurance Sales,Medicare,Phone Etiquette

Employment Type : Full-Time

Experience : years

Vacancy : 1