Insurance Supervisor

Position Summary

Under direct supervision, the incumbent is responsible for the oversight and management of all insurance billing and collection operations of Union General Health System in accordance with established standards, guidelines, and requirements. Work requires leadership and workforce management skills, proactive troubleshooting, significant attention to detail and the application of analytical / critical thinking skills to analyze denials and reimbursement methodologies and bring timely resolution to issues that have an impact on revenues.

Responsible for planning, implementing, and directing the daily process of insurance billing and claims resolution work flow processes within the Central Business Office. Develops and executes strategies that are focused upon achieving outstanding results, operational excellence, and improved patient experience. Continuously strives for excellence resulting in overall operational effectiveness and excellent revenue cycle performance through daily management of the Key Performance Indicators.

Responsible for the coordination, standardization, work integration, change management, issue resolution, measurement and communication related to billing and claims management.

Accomplishes appropriate, effective, and timely personnel functions within the Central Business Office which includes employee recruitment, new employee orientation and training, performance evaluations, continuing education, employee counseling, and problem resolution. Confers with Director – Revenue Cycle regarding personnel issues.

Principal Duties and Responsibilities

The following section contains representative examples of job duties that might be performed in positions allocated to this job class. Union General Health System is a dynamic organization, and the environment can be fluid. Roles and responsibilities may be altered to accommodate changing business conditions and objectives as well as to tap into the skills and experience of its employees. Accordingly, employees may be asked to perform duties that are outside the specific work that is listed. It is not required that any position perform all duties listed, so long as the primary responsibilities are consistent with the work as described. Performance standards developed for incumbents allocated to this job class may also contain relevant job content information and are referenced hereto.

• Responsible for planning, implementing, and directing the daily process of insurance billing and claims resolution work flow processes within the Central Business Office. Develops and executes strategies that are focused upon achieving outstanding results, operational excellence, and improved patient experience. Continuously strives for excellence resulting in overall operational effectiveness and excellent revenue cycle performance through daily management of the Key Performance Indicators.
• Responsible for the coordination, standardization, work integration, change management, issue resolution, measurement and communication related to billing and claims management.
• Measures and reports noteworthy statistical and status information related to unbilled claims, unpaid claims, and denial management.
• Monitors and reports status and progress to the Director – Central Business Office and key stakeholders.
• Prepares accurate routine and requested reports on the status of the Central Business Office.
• Reviews system reports daily and makes required corrections.
• Implements plans/projects to improve operational efficiency and effectiveness.
• Identifies opportunities to leverage systems, processes, or standardizations to improve billing and claims resolution.
• Serves as the subject matter expert in all matters pertaining to billing, reporting, and reimbursement.
• Demonstrates knowledge of regulatory billing requirements while staying abreast of new developments.
• Researches and analyzes data to determine areas of opportunity.
• Conducts timely reconciliation and audits of billing documentation and data while creating solutions.
• Resolves escalated patient / account issues
• Controls and monitors denied / rejected claims to ensure appropriate re-bills and appeals are conducted with the established time frame.
• Accomplishes appropriate, effective, and timely personnel functions within the Central Business Office which includes employee recruitment, new employee orientation and training, performance evaluations, continuing education, employee counseling, and problem resolution. Confers with Director – CBO regarding personnel issues.
• Conducts ongoing in-service education on specific requirements for all billing positions within the Central Business Office.
• Monitors productivity for all areas and ensures that the scheduling is adjusted based on workload.
• Conducts routine Billing Quality Assurance for all employees. Assists employees in obtaining excellent QA scores by identifying opportunities for additional education and providing the education.
• Establishes and maintains the appropriate documentation and statistical records to provide for complete accountability of patient account transaction as required by law and/or fiscal intermediaries.
• Seeks ways to maximize reimbursement and better serve the patient needs.
• Appropriately maintains automated billing system files and tables to ensure accurate generation of appropriate claim forms in accordance with the payer requirements.
• Participates in patient accounting system upgrades and testing to ensure accurate claims generation
• Ensures strong employee communication by conducting department meetings and monthly staff interviews.
• Facilitates the work of the Director – Central Billing Office
• Other duties as assigned.

Position Qualifications

Education

• High School Diploma or GED equivalent is required.
• Bachelor’s Degree in related field is preferred – experience in lieu of education may be substituted

Experience

• Previous supervisory experiences preferred
• Five years Billing / AR – Denial Management with hospital and/or professional claims which demonstrates attainment of the required requisite job knowledge and abilities.
• Demonstrated knowledge of Federal / State Regulations and commercial insurance guidelines, payer contracts, and basic medical terminology and abbreviations

Knowledge, Skills, Abilities

• Proficient in Microsoft Office products, specificallyExcel
• Proven leadership skills and ability to gain cooperation and support from a diverse body of individuals
• Highly dependable in both production and attendance
• Ability to effectively prioritize and execute tasks while under pressure; make decisions based on available information and within the scope of authority of the position; excellent customer service skills, including professional telephone interactions.
• Exceptional organization, problem solving, and time management skills with an attention to detail
• Excellent verbal and written business communication skills sufficient to clearly document issues and effectively communicate.
• Promote the mission, vision, and values of Union General Health System.
• Maintain confidentiality of all patient, medical, financial, and legal information.
• Represent the organization in a positive & professional manner.
• Ability to handle difficult situations involving patients, physicians, staff and others in a positive and professional manner.
• Comply with all organization policies and standards
• Consistently demonstrate the value of team concept.
• Understands and abides by OSHA, HIPAA and CLIA standards
• In-depth understanding of HIPAA regulations and proven ability to ensure confidentiality with respect to sensitive information