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POSITION SUMMARY
This position will oversee back-end revenue cycle operations including monitoring of timely claim submissions, collections, reimbursements and will be responsible for the oversight of rejection processing for all insurance carriers and patient accounts, while meeting the performance standards and goals of the department.   This position will guide the department to improve service levels through continuing education and by implementing innovative technology and collection techniques. 

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. 

CORE FUNCTIONS

1. Hires, trains and conducts performance evaluations, and supervises the workflow for the designated staff.  Provides leadership, coaching, recognition, staff development, and disciplinary actions.  Establishes priorities, workloads, controls and work procedures, as well as determines resources needed.

2. Oversees the department ensuring all insurance claims, patient submissions, appeals and reimbursement denials are handled in a timely and professional manner in accordance with departmental policies, procedures and performance goals. Oversee audits on production standards and service quality and counsel staff accordingly.  Provide trend reporting on weekly/monthly aging and collection issues for management.  Schedules and manages the use of labor and resources within budgetary guidelines.

3.  Provides instruction to staff on updated collection techniques and develops departmental best practices, as well as creates standard operating procedures for implementation; conducts annual review of all departmental standard operating procedures for accuracy.  Utilizes Six Sigma concepts and drives tools and methodology usage in the department.

4. Reviews and analyzes reimbursement, aging and collection reports to ensure prompt resolution to escalated issues in accordance with departmental policies, procedures and generally accepted accounting principles as well as all applicable laws and regulations. 

5. Promote effective communication between reimbursements team and third party and government payer relations via in-person meetings, phone calls and written correspondence.

6. Oversee the reimbursement, claims and collection process to ensure all compliance, contractual, regulatory and legal obligations are adhered to. 

KNOWLEDGE/SKILLS/ABILITIES

• Ability to clearly and efficiently communicate complex issues using strong verbal and written aptitude.
• Extensive knowledge of billing, insurance, computer systems, and medical billing processes.  
• Ability to prioritize and complete multiple tasks.

​MINIMUM QUALIFICATIONS

• A strong knowledge of business and/or healthcare as normally obtained through a Bachelor’s Degree or equivalent professional experience.
• Three (3) years’ of experience in the healthcare industry and/or third-party receivables and collections.  
• Two (2) years of previous leadership experience, as normally demonstrated through a lead, assistant supervisor, or supervisor job role. 
• Must communicate effectively in oral and written formats. 
• Proficient with Windows, Excel and Word; must demonstrate excellent employee relation skills and behaviors consistent with the values of the Integrated Laboratory.

PREFERRED QUALIFICATIONS

• Prior laboratory billing experience. 
• Knowledge of commonly used medical billing terminology including ICD-10 coding, CPT and HCPCS coding. 

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