Insurance Claims & Denials Supervisor

The University of Texas Rio Grande Valley Job Site; Harlingen (TX); Presencial; USD 64.000 - 90.000; Tempo integral

Resumo da vaga

The University of Texas Rio Grande Valley is seeking a Revenue Cycle Supervisor to oversee third-party payer claim functions, focusing on follow-up, denials, and collections. The role ensures regulatory compliance and optimizes reimbursement for services rendered.

Responsibilities include coaching staff, monitoring denials, using Power BI to track performance, and collaborating with coders and clinic teams.

Qualificações

• Four (4) years of medical, hospital, or healthcare revenue cycle related experience, including thorough knowledge of registration, scheduling, pre-certification, prior authorization, coding, claims billing and insurance follow-up, payer reimbursement, posting, and collections processes.
• Excellent verbal and written communication skills; ability to educate/train others and foster a cooperative work environment.
• Knowledge of CPT4, ICD10, HCPCS codes and modifiers; proficient with Microsoft Office applications.
• Associate degree in healthcare-related field or equivalent experience in lieu of degree.

Responsabilidades

• Oversees and coordinates the day-to-day operations of all third-party payers claims functions, including follow-up, denials, and rejections.
• Ensures adherence to third party payer regulatory guidelines, department policies, and procedures.
• Monitors denial management to ensure corrective actions by billing staff to obtain full reimbursement.
• Works with billing specialists to ensure proper follow-up, collections, and appeals in compliance with policies.
• Provides coaching and training to new hires and existing staff.
• Monitors workflow and directs tasks to manage fluctuating volumes.
• Reviews Power BI dashboards to ensure AR follow-up, denials, and adjustments meet productivity and quality goals.
• Communicates regulatory changes to management and denial teams promptly.
• Reviews and identifies denial trends to minimize financial losses and improve processes.
• Oversees write-offs for adjustments and prepares manual adjustments as needed.
• Evaluates accounts to ensure all third-party reimbursement options have been exhausted.
• Prepares reports on key quality and productivity indicators for upper management.

Conhecimentos

Communication skills

Analytical skills

CPT4/ICD10/HCPCS knowledge

Microsoft Office

Formação

Associate Degree in Healthcare related field

Ferramentas

Excel

Word

PowerPoint

Descrição da vaga

The University of Texas Rio Grande Valley is seeking a Revenue Cycle Supervisor to oversee third-party payer claim functions, focusing on follow-up, denials, and collections. The role ensures regulatory compliance and optimizes reimbursement for services rendered.

Responsibilities include coaching staff, monitoring denials, using Power BI to track performance, and collaborating with coders and clinic teams.