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Supervisor - Third Party Follow-up
3 months ago
Overview:
Our team members are the heart of what makes us better.
At
Hackensack Meridian _Health_** we help our patients live better, healthier lives — and we help one another to succeed.
Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
The
Supervisor of Third Party Follow Up in the Hackensack Meridian _Health_ Network (HMH) supervises the third-party follow-up staff and work flow, and is responsible for the operation of following up with carriers for payments of claims, controlling denials, evaluating staff, time and attendance and all other aspects of department needs.
Primarily responsible for HMO, Blue Cross Blue Shield Managed Care, Government payers and Commercial accounts, as assigned, in the the HMH Network.
Responsibilities:
A day in the life of a
Supervisor of Third Party Follow Up at Hackensack Meridian _Health_ includes:
- Plans, coordinates, and schedules the daily operations of the Department in compliance with carrier's regulations and collection of outstanding claims for the business office for all assigned payers.
- Oversees the daily supervision of the Department.
- Involved in the Denial Management review of denied accounts. Keeps Manager informed of all system issues and consults for direction as necessary.
- Monitors the status of billed claims, monitors aged receivables, and escalates any issue accounts with payers to Manager.
- Responsible for understanding and executing new regulations from payers.
- Utilizes EPIC system to generate analysis reports and corrective actions if needed.
- Initiates contact with payers as necessary to investigate or resolve denials.
- Provides coaching, training, and performance evaluations to staff as necessary.
- Reviews the staff productivity to determine quantity and quality of work on a regular basis.
- Counsels staff, provides written disciplinary actions, and Performance Improvement Plans, as necessary.
- Oversees special projects and audits as assigned.
- Identifies and suggests resolution for problems involving issues that impact Third Party Follow-Up productivity or data quality. Presents ideas at meetings, to other members of the Management team, and/or Senior Leaders.
- Contacts provider representatives at payers and escalates issues appropriately and timely.
- Interacts with external departments such as (HIM, Audit/Compliance, Pharmacy, Clinical areas) to resolve issues in a timely manner. This includes supplying Medical Records upon requests from vendors and other appropriate parties.
- Maintains manuals with current departmental policies and procedures.
- Maintains time and attendance records for the staff utilizing the Clairvia and PeopleSoft systems for electronic attendance management, and ensures policies are followed by the department.
- Maintains high level of knowledge of the claims scrubber system (currently ePremis) and the Medical Center's main patient accounting system (i.e. Epic).
- Other duties and/or projects as assigned.
- Adheres to HMH Organizational Competencies.
Qualifications:
Education, Knowledge, Skills and Abilities Required:
- BA/BS degree in accounting, business, healthcare administration or related field; or equivalent relevant HMH experience at approximately 6-8 years.
- Minimum of 4 years' experience in healthcare billing or health insurance claims environment. Familiar with medical billing practices, concepts, and procedures.
- Ability to work in a fastpaced business office; must be able to coordinate multiple projects with multiple deadlines or changing priorities.
- Excellent analytical and critical thinking skills.
- Strong attention to and recall for details.
- Prior experience with an electronic billing system/claims editor.
- Must be highly organized and possess excellent time management skills.
- Strong written and verbal communication skills.
Education, Knowledge, Skills and Abilities Preferred:
- Prior experience supervising people and delegating tasks.
- Prior experience in a Patient Financial Services/Patient Accounting Department for a University Medical Center, Hospital, or Health Insurance organization.
- Extensive understanding of inpatient and outpatient hospital billing practices.
- Experience with EPIC and ePremis a plus, Real Time Eligibility tools, payer portals.
Licenses and Certifications Required:
- Successfully pass EPIC online Patient Accounting and Reconciliation courses within 6 months of hire and/or promotion into this position.
- Successfully pass completion of EPIC assessment within 30 days after Network access granted.
