Job Description
ECU Health
About ECU Health Medical Center
ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.
Position Summary
The Supervisor will work closely with the Manager/Director to manage hospital and physician follow-up/collections of outstanding claims, employee productivity and ongoing improvement tracks all efforts and outcomes related to key revenue cycle indicators. These key indicators include but are not limited to, AR days, and follow-up productivity. This position will supervise personnel development, implementing and maintaining policies. Responsible for mentoring/coaching as well as all aspects of performance management of staff. Ensures claims are adjudicated timely and accurately.
Responsible for the collection of hospital and physician accounts for our Government/Non-Government payers. Supervises the daily activities of the team, ensuring timely follow-up actions occur and are in compliance with the rules, regulations and contractual obligations of our Managed Care and third-party payers. Monitors work queues and schedules audits to ensure the timeliness and accuracy of collection activities and adjust work queues based on volume and priority. Supervises account receivables (A/R) to ensure timely follow-up occurs and appropriate collection efforts are made regarding Managed Care carriers, and other payor sources.
Monitors reports to identify additional process improvement opportunities. Assigns work based on staffing levels and workload to optimize productivity and meet department standards. Communicates with clinical and non-clinical staff, physicians and leadership to manage department operations.
Responsibilities
1. Provide daily supervision and support to team to ensure they are working effectively and correctly completing assigned tasks.
2. Troubleshoot problematic accounts, identify trends, and root causes, and lead internal and interdepartmental initiatives to resolve issues.
3. Supervise daily operations consistent with the departmental goals.
4. Demonstrates ability to take direction, coordinate projects and prioritizes assignments on individual basis as well as on a departmental level.
5. Ability to research, acquire, evaluate, interpret and utilize payer specific policies, guidelines and statutory authorities as appropriate for insurance collection follow-up.
6. Maintains operations by ensuring compliance with all appropriate internal policies and procedures and external regulatory and accrediting agencies.
7. Supervises staff and ensures staff understanding of current policies and procedures.
8. Performs internal auditing of production to ensure compliance and identify training opportunities.
9. Routinely monitor staff performance and report to Manager and Director any areas of continual concern for improvement.
10. Communicate to team daily, weekly and monthly results to include reasons for process bottlenecks, collection shortfalls and operational successes.
11. Manages accounts receivable follow-up processes and workflows.
12. Understands, develops, implements, and analyzes key performance measures for continuous improvement. Identifies specific trends or issues and communicates status and resolution with leadership.
13. Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks.
14. Supervise resolution of claims with individual insurance carriers or agencies.
15. Maintain continual knowledge of payor policies to assure optimal reimbursement for all services performed within the system, in compliance with government and third-party payor regulations.
16. Participate in provider and third-party vendor conference calls regarding billing/reimbursement issues and trends, as well as Contract Interpretation and Joint Operating Committee meetings.
17. Recommends procedural and system changes to improve processes, operational quality and efficiency, i.e., job aides, training resources, and workflow; actively participates in process improvement projects.
18. Develops and recognizes staff through coaching, planning, training, appraising, and counseling employees.
19. Conduct weekly AR team meetings and 1:1 meeting.
20. Provide an environment for staff members to meet goals and to be successful.
Skill Set Requirement:
Knowledge of revenue/billing cycle and charge capture is preferred.
Knowledge of medical terminology.
Written and verbal communication skills. (exceptional communication, interpersonal, listening, coaching, facilitation and conflict resolutions skills)
Proficient in using Microsoft products like Excel, word, PowerPoint, outlook, one drive.
Computer, analytical, reporting and organizational skills
Must have knowledge of medical practice operations.
Billing/collection practices and methodologies.
Basic knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding)
Governmental legal and regulatory provisions related to claims resolution activities.
Skill in establishing and maintaining effective working relationships with other employees, patients, physicians, insurance organizations, and the public.
Requires a hands-on leader with the ability to prioritize, plan, and supervise Hospital, and Professional Claims Follow-up Department.
Minimum Requirements
Required Education/Course(s)/Training:
High School Diploma, equivalent or higher
5+ years of experience in professional and hospital revenue cycle account receivable management including government payers is required.
2+ years in a lead or supervisory role within professional and hospital centralized healthcare environment.
Preferred Education:
Associate degree in healthcare administration or related field of study
Required Certification/Registration: None
Performance Expectations:
Successful achievement of the following:
Must be able to work independently and efficiently with little supervision.
Must have a strong desire to teach / transfer knowledge to team members.
Ability to recognize, evaluate, solve problems, and correct errors.
Must demonstrate ability to work in fast-paced environment.
Demonstrates leadership and group cohesive skills that promote teamwork and group achievement.
Show proficiency in building and maintaining strong internal relationships while motivating and inspiring team members through effective consultative skills.
Ability to identify and implement process improvements to optimize revenue cycle performance.
General Statement
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.