A/R Insurance Supervisor - Facilities

Job Description

Job Description

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