A/R Insurance Supervisor - Facilities

ESSENTIAL FUNCTIONS

• Responsible for supervising and developing patient account and insurance follow-up representatives.


• Assist staff with timely identification of denial trends and work with team to initiate workflows to resolve future denials.


• Supervise daily operations of the facility authorization team including scheduling, task delegation, and performance monitoring.


• Ensure timely and accurate pre-authorization of surgical procedures, diagnostic testing, inpatient admissions, and other billable services.


• Review authorization and insurance verification workflows to improve efficiency and reduce errors and delays.


• Serve as the point of contact for escalations involving urgent or complex authorization issues.


• Monitor payer policies and communicate changes or updates to the team promptly.


• Collaborate with clinical departments, schedulers, physicians, and billing to ensure accurate communication and coordination of services.


• Track and report key performance indicators (KPIs) including authorization turnaround times, denial rates, and retro-authorization volumes.


• Assist with training, coaching, and developing authorization team staff.


• Ensure compliance with HIPAA and other applicable federal, state, and payer regulations.


• Partner with billing and coding teams to review and resolve retroactive authorization issues and prevent revenue leakage.


• Perform quality auditing on live and retrospective auditing of inbound and outbound phone calls.


• Performs monthly billing audits to ensure timely and accurate claims submission and insurance follow-up activities.


• Coaches established employees when needs are identified, holding employees accountable for results through coaching and development of action plans.


• Performance management of personnel including reviews, corrective action, mentoring, and development plans and performance improvement plans.


• Assist in interviewing, hiring, and training of new staff members.


• Monitor and manage the productivity and performance of assigned employees including reporting daily/weekly/monthly department metrics to Senior Management.


• Responsible for handling escalated patient phone calls regarding billing and payment issues.


• Acts as a resource to the department taking inbound phone calls to provide coverage for breaks and lunches.


• Review patient accounts for accurate customer service, supporting documents, and correct collections activity.


• Support and comply with all company policies and procedures and comply with Medicare and Medicaid regulations.


• Conducts regularly scheduled staff meetings.


• Research and resolve discrepancies in a timely manner.


• Review and assist with processing refunds, turning accounts to collections and financial assistance applications.


• Responsible for accurate and timely application of transactions including adjustments and write-offs.


• Communicate effectively with other internal departments and with outside vendors, such as, phone system, collection agency and credit card processor.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• Requires 2+ years of experience acting as a team lead or in a supervisor role in a revenue cycle department in a healthcare environment.

REQUIREMENTS

• Must have a full understanding of the Revenue Cycle Management process to include collections, billing, and coding


• Excellent critical thinking, troubleshooting, and analytical skills


• Excellent interpersonal skills including conflict management


• Experience working in Microsoft products – Word, Outlook, and Excel (advanced formulas, pivot table)


• Well organized and able to meet deadlines


• Excellent attention to details


• Works with sensitive and confidential materials and must be able to exercise discretion.

KNOWLEDGE

• Knowledge in patient billing, healthcare administration, healthcare insurance requirements, and medical terminology and coding.


• Knowledge of business office methods and policies regarding productivity/workload analysis and scheduling procedures.


• Knowledge of government regulatory requirements and commercial contracts.

SKILLS

• Skilled in defusing difficult situations while remaining calm and exhibiting professionalism and courtesy.


• Skilled in establishing metrics and clear objectives including performance management.


• Skill in effectively managing multiple projects simultaneously.

ABILITIES

• Ability to multi-task and work well under pressure


• Ability to analyze problems and interpret information and to prioritize and reprioritize, as necessary.


• Ability to work independently, and as part of a team.


• Ability to work in a fast-paced environment                                                                                                                                         

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.


• Extended work hours at or near month end to meet department objectives may be necessary.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.


• Some bending and stretching required. Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision and Values must be acknowledged and adhered to