We partner with healthcare providers to maximize reimbursement from complex claims payers by having the best people, processes, products and performance.
We enable healthcare providers to do what they do best.
The Supervisor, Revenue Services - Veteran's Administration, Physician oversees a team of Veteran Administration, Physician Revenue Specialists and serves as the internal escalation point for claim processing resolution. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.
- Responsible for the daily supervision of assigned Revenue Services teams.
- Serves as the primary escalation point, to directly or through staff, work with clients to resolve roadblocks that may hinder the claims resolution process and provides direction to Revenue Specialists to resolve existing claims.
- Partners with Sr Ops Manager to disseminate priority of daily tasks to his/her assigned team.
- Prepares performances evaluations and account reviews and plays a role in delivering both documents in conjunction with the Sr Ops Manager.
- Analyze and evaluate Veteran Administration, TriWest, and Tricare claim payments using EnableComp's proprietary software, systems and tools. Use payment documentation provided by payers to determine if the medical provider has been reimbursed in compliance with the applicable Medicare or Federal contract rates.
- Research, request and acquire all pertinent medical records and any other supporting documentation necessary and then submit with hospital claims to insurance companies to ensure prompt correct claims reimbursement.
- Conduct timely and thorough telephone follow-up with the Veterans Administration to ensure proper reimbursement.
- Prepare correct Veteran Administration initial bill packet using EnableComp systems tools and
- Works with Data Analytics team to research issues with claim and payment imports, etc.
- Trains and mentors staff as needed including new hires, especially in regards to ongoing training needs that may result from the SOP for goal escalation in alignment with core values and mission statement.
- Works with Data Quality team to research issues with calculations and other projects.
- Works with Document Management team to remove roadblocks around document acquisition and other requisite items needed to collect accounts.
- Perform Quality Control tasks on behalf of management regarding account flow and due diligence.
- Authority to recommend staff hires or terminations as necessary to enable it to achieve the approved strategy.
- Other duties as required.
Requirements and Qualifications
- High School Diploma or GED required. Associates or Bachelor's Degree a plus.
- 5 years' experience in healthcare field working in billing or collections.
- 5 years' client facing/customer services experience.
- 1-2 years supervisory or team lead experience.
- 3-5 years' experience with complex billing and collections preferred.
- Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
- Equivalent combination of education and experience will be considered.
- To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.
Special Considerations and Prerequisites
- Must demonstrate exceptional interpersonal skills and exhibit an approachable nature to answer questions from Revenue Specialist staff, mentor, and train others regularly.
- Timely and regular attendance.
- Must be a self-starter and able to work independently without direct supervision.
- Proven written and verbal communication skills.
- Strong analytical and problem-solving skills.
- Appropriately handle stress and interact cooperatively with others (at all levels of the organization).
- Proven experience working with external clients; strong customer service skills and business acumen.
- Ability to prioritize and manage multiple competing priorities and projects concurrently.
- General office environment; must be able to sit for long periods of time.