Summary
Supervises employees engaged in customer service, clerical support, insurance billing, collections, cash application, and/or refunds to TMC HealthCare patients. Ensures that documentation is accurate, financial information is verified, and provides information to appropriate personnel in a timely manner.
Summary
Supervises employees engaged in customer service, clerical support, insurance billing, collections, cash application, and/or refunds to TMC HealthCare patients. Ensures that documentation is accurate, financial information is verified, and provides information to appropriate personnel in a timely manner.
Essential Functions
- Performs supervisory functions; prepares work schedules, assigns staff, observes and reviews performance to provide input to formal evaluations, and makes recommendations for personnel actions; assists in staff selection and provides orientation, training and ongoing in-services for staff.
- Works with payor representatives on complex, problematic accounts troubleshooting and identifying trends in payor claim denials or complex issues.
- Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff.
- Adheres to and supports staff in exhibiting TMCH values of integrity, community, compassion, and dedication.
- Demonstrates and upholds established standards of behavior, safety, and confidentiality, as well as TMCH and department policies and standards.
- Ensures compliance with all applicable regulatory requirements.
- Provides input for budget preparation and monitors/controls expenses within approved budget allocations.
- Collects accounts not paid in full at time of discharge or promised date; recommends use of collection agencies or legal services for delinquent accounts.
- Answers all inquiries regarding accounts.
- Prepares reports reflecting status of billing, credit and collection activities.
- Supervises policy and procedures relating to credit and collections; assumes responsibility for all accounts within one or more financial classes.
- Evaluates agency performance and recommends changes as required.
- Resolves complaints/concerns within TMC HealthCare guidelines and patient satisfaction.
- Monitors reconciliation of daily cash and posted payments to accounts receivable.
- Evaluates procedures to improve methods for controlling payor and patient account receivables.
- Oversees refunds and contractual write-offs.
- Maintains department records, reports, and files as required.
- Reviews reports related to generated edits and aging accounts receivable.
- Maintains and manages the credit balance report within the department’s established guidelines.
- Evaluates pre bad debt reports and makes recommendations to management.
- Adheres to TMCH organizational and department-specific safety, confidentiality, values policies and standards.
- Performs related duties as assigned.
Minimum Qualifications
EDUCATION: Associates Degree (A.A.) or equivalent from an accredited two-year college or technical school, or an equivalent combination of relevant education and experience on a year-for-year basis.
EXPERIENCE: Four (4) years related medical billing, insurance, customer service or scheduling experience, preferably in a lead or supervisory role.
LICENSURE OR CERTIFICATION: None required.
Knowledge, Skills and Abilities
- Knowledge of electronic billing and any necessary systems related to Patient Accounting.
- Knowledge of codes related to patient billing including revenue codes, and all diagnostic related codes.
- Knowledge of medical insurance practices and policies and regulations.
- Knowledge of government and non government uniform billing guidelines.
- Knowledge of medical terminology and coding.
- Skill in evaluating claims and itemized statements in order to collect in a timely manner.
- Skill in evaluating employees and processes and providing recommendations for improvement.
- Skill in leading and training staff.
- Proficient in use of Excel, Word, Internet, email, and financial software programs and network systems.
- Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations.
- Ability to write reports, business correspondence and procedure manuals.
- Ability to effectively present information and respond to inquiries or complaints from employees, patients, and/or their representatives, and the general public.
- Ability to calculate figures and compute rate, ratio, and percent and to draw and interpret bar graphs and apply basic algebraic concepts.
- Ability to apply common sense understanding to carry out detailed written or oral instructions.
- Ability to solve problems involving complex variables in standardized situations.