Supervisor, Denials and Appeals

POSITION SUMMARY:

The Supervisor, Denials and Appeals supervises a team of Revenue Cycle Analysts and Denials and Appeals Specialists, dedicated to executing insurance discovery to claims and denial management. This role drives consistency & accuracy of third-party payor billing information and improves the process of claims processing and revenue recovery.

PRIMARY RESPONSIBILITIES:

• Supervise team by monitoring production and quality to specified goals.
• Assists with feedback for hiring, discipline and performance evaluations.
• Oversees the process of providing coverage within a high production environment.
• Provides department orientation for all direct reports and coordinates training per job description.
• Ensures that on-going training is provided for established employees, including the development & maintenance of standard operating procedures.
• Liaisons with internal departments to promote ongoing communication and ensure accuracy.
• Acts as an escalated level of response for concerns and complaints.
• Assists staff with enforcing policy.
• Works with cross functionally to manage the entire process from insurance verification to final collection.
• Monitors and validates adherence to policies and procedures, auditing as necessary.
• Completes projects and reports in a timely fashion on a daily, weekly or monthly basis per the direction of management.
• Develops, monitors, coaches, and manages staff, ensuring the development of employees through orientation, training, establishing objectives, communication of rules, and constructive discipline.
• Promotes a positive working environment through role modeling, team development, respect, and being fair and consistent.
• This role may have occasional access to PCI and PHI both in paper and electronic form and could have occasional access to various technologies to access PCI and PHI (paper and electronic) in order to perform the job

PREFERRED KNOWLEDGE, SKILLS AND ABILITIES:

• Thorough knowledge of the healthcare reimbursement environment (government and private payers) including coverage, coding and payment and understanding of insurance billing practices.
• Demonstrated ability to develop and analyze payments, diagnose issues, and present findings to management.
• Must be able to communicate effectively both orally and in writing. Strong interpersonal skills.
• Strong organizational skills; attention to detail.
• Ability to proficiently use a computer and standard office equipment.
• Working knowledge of Microsoft Office, primarily Excel
• Previous experience with Google Enterprise Suite – Gmail, Slides, Sheets, Docs, Drive.
• Knowledge of the claim life cycle, payer contracts and eligibility, and denial research.
• Healthcare research and analysis skills sufficient to support payer research through healthcare policy library and state management.

QUALIFICATIONS:

• Bachelor’s degree or equivalent work experience. A degree in business administration, accountancy, healthcare administration or similar is preferred.
• Minimum of 2 years directly related and progressively responsible experience.
• Lead and/or supervisory experience.
• Experience with insurance denials/appeals and claims management software.

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