RCM Supervisor, Billing

POSITION:  RCM Supervisor, Billing

RESPONSIBLE TO: RCM Manager

JOB SUMMARY: The position will be responsible for developing and establishing the guidelines/policies/procedures for the program, determine proper staffing, preparing, and maintaining relevant guidelines for billing to each insurance carrier, coaching and training the staff, tracking and trending for the continued development of the rules in Encoda, and developing creative solutions for any challenges.

RESPONSIBILITIES INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING:

GENERAL SCRUBBING DUTIES

Responsibilities include, but are not limited to, the following

• Retrieve claims from the Electronic Medical Records (EMR).
• Review charges for accuracy
• Review EMR documentation where appropriate
• Review diagnosis coding for known appropriateness for the visit and for the carrier guidelines
• Re-sequence diagnosis codes as appropriate
• Review charges, diagnosis pointers, modifiers, and NDCs (if necessary) are correct and there are no duplicates.  
• Ensure that the correct provider, site, insurance, filing type, and referrals/auths are selected.
• Ensure there are no duplicate charges
• Communicate with appropriate person(s) with any questions or concerns.  This could include - but not limited to - hub personnel, provider, coding team and others within the RCM.
• Approve and batch the claims.
• Work exceptions caught by system scrubbing.
• Approve and batch the claims.
• Periodically check for Unretrieved Charges.
• Communicate with others of observed trends.
• Recognizing the need for additional scrub rules based on trends.
• Work front end rejections to ensure delivery to payer

SUPERVISORY DUTIES

• Establishment of and maintenance of guidelines for the department, including working documents, policies and procedures, and relevant guidelines for specific carriers.
• Conduct meetings with the team to answer questions as a part of ongoing training, discuss error trends, process failures and adherence to set processes and procedures.
• Provide ongoing training and support of team.
• Keep open communication with Management on challenges, trends, and ways to improve processes.
• Supervise Scrubbing department staff.

OTHER

• Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
• Attends all meetings as requested including regular staff meetings.
• Attends Medicare and other continuing education courses as requested.  Pursue and participate in education to remain current with changes in the Healthcare industry.
• Performs any additional duties as requested by RCM Leadership.
• Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
• Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.
• Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies

SUPERVISORY RESPONSIBILITIES

• This position supervises the RCM Billing Specialists

EDUCATIONAL REQUIREMENTS:

• High school diploma or GED equivalent.
• College education or trade school preferred.
• Certified CPC preferred

QUALIFICATIONS AND EXPERIENCE:

• Previous Medical Billing experience preferred. Preference for those with a minimum of eighteen months experience.
• Comfortable using email and interacting with Internet applications
• Knowledge of practice management and Microsoft processing software
• Proven understanding of Explanation of Benefits forms, claim forms and the insurance billing process
• Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement
• Basic knowledge of CPT and ICD-10 coding
• Strong written and verbal communication skills