SUPERVISOR, PFS (13700)

Job Summary:

• Ensure accurate and complete posting test, entering orders, verifying medical necessity, and confirming precertification.
• Assist with obtaining new orders if medical necessity is not met and/or pre-certifications are not obtained.
• Verify all physician orders have required information (Physician signature, patient's full name, DOB, diagnosis/reason, and date) and are scanned into hospital system.
• Work with access and/or physician offices to assure late add-ons are managed properly.
• Review next day schedules to confirm all patients are completed and obtain any additional information needed.
• Communicate regularly to update and validate comprehension by staff of scheduling guidelines from all scheduling centers and adhere to all procedural protocols.
• Monitor daily workflow and staff productivity to ensure departmental goals and performance standards are met.
• Oversee claim submission and follow-up processes to minimize denials, delays, and outstanding accounts receivable.
• Review denied and rejected claims, working with the team to identify root causes and develop corrective action plans to improve reimbursement.
• Ensure timely and accurate resolution of billing discrepancies, claim edits, payer issues, and patient account concerns.
• Develop staff education and training related to billing procedures, payer requirements, denials, and revenue cycle processes.
• Serve as a resource and escalation point for complex billing and reimbursement issues.
• Assist management with staffing, scheduling, workflow development, and departmental policies.
• Ensure staff is trained/updated on CPT changes, insurance precertification requirements and medical necessity changes.
• Manage to ensure department is adequately staffed and new employees are thoroughly trained.
• Demonstrate and encourage team behavior and exceptional patient/guest experiences.
• Uphold and promote patient safety and quality.

Education: 

High school diploma or equivalent required. Certification or associate's degree in coding is preferred. Must have in-depth knowledge of medical terminology.

Experience: 

Two years' medical terminology experience required; supervisory experience preferred. Phone experience and previous medical office experience are preferred.

Additional Skills/Abilities: 

Computer experience required. Must be able to type 30 WPM. Must be able to communicate well with physician office staff and adjoining departments within organization. Must be able to develop and implement policy and procedures and training documents as needed by the department.