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Financial Case Management Supervisor

4 months ago

Falls Church, Virginia, United States Chapters Health System Full time
It's inspiring to work with a company where people truly BELIEVE in what they're doing

When you become part of the Chapters Health Team, you'll realize it's more than a job. It's a mission. We're committed to providing outstanding patient care and a high level of customer service in our communities every day.

Our employees make all the difference in our successRole:

The Revenue Cycle Manager is responsible for managing the daily operations of insurance verification and authorization processes including nursing home room and board invoicing and Medicaid eligibility screening process.

This position also oversees the Revenue Cycle Quality Assurance (QA) Team, which is tasked with enhancing the effectiveness of net patient revenue realization and minimizing revenue leakage across all services lines as well as ensuring compliance with CHS policies and procedures in addition to providing administrative oversight and maintaining all revenue cycle related systems.


Qualifications:

  • Bachelor's degree or an equivalent combination of experience and education
  • Minimum of five (5) years of related insurance verification and authorization experience, preferably in a consolidated business office environment
  • Minimum of one (1) year of supervisory experience
  • Strong management skills including motivating and mentoring people at all levels, training, establishing departmental policies and procedures and managing human resource issues of staff supervised
  • Customer service skills, interpersonal skills, ability to work independently, ability to work with a team, critical thinking, organizational skills, and knowledge of regulatory requirements appropriate for the position
  • Knowledge of third party billing and regulations required; knowledge of state and federal collection regulations preferred
  • Ability to manage in a fast pace environment, remaining proactive, detailed oriented, resourceful and efficient, with a high level of professionalism
  • Strong computer skills with Excel, Word, PowerPoint, and database management

Excellent written and verbal communication skillsCompetencies:

  • Satisfactorily complete competency requirements for this position

Responsibilities of all employees:

  • Represent the Company professionally at all times through care delivered and/or services provided to all clients.
  • Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
  • Comply with Company policies, procedures and standard practices.
  • Observe the Company's health, safety and security practices.
  • Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
  • Use resources in a fiscally responsible manner.
  • Promote the Company through participation in community and professional organizations.
  • Participate proactively in improving performance at the, departmental and individual levels.
  • Improve own professional knowledge and skill level.
  • Advance electronic media skills.
  • Support Company research and educational activities.
  • Share expertise with co-workers both formally and informally.
  • Participate in Quality Assessment and Performance Improvement activities as appropriate for the position

Leadership Success Factors:

  • Communication. Express thoughts and ideas clearly. Adapt communication style to fit audience.
  • Initiative. Originate action to achieve goals.
  • Management Identification. Identify with and accept the problems and responsibilities of management.
  • Judgment. Make realistic decisions based on logical assumptions which reflect factual information and consideration of organizational resources.
  • Planning, Organizing and Controlling. Establish course of action for self and/or others to accomplish a specific goal; plan proper assignments of personnel and appropriate allocation of resources. Monitors results.
  • Leadership. Use appropriate interpersonal styles and methods in guiding others toward task accomplishment.
  • Ethics. Model highest standards of conduct and ethical behavior, adopting a strong position against fraud and abuse.

Regulatory Compliance:
Educate and monitor staff regarding their own and the organization's responsibilities for regulatory compliance

Job Responsibilities:

  • Provides leadership and directs the daily operational responsibilities of the Insurance Verification and Authorization department. Manages performance of staff and provides routine performance evaluations.
  • Delegates/oversees the work assigned to the QA team. Reviews monthly productivity and quality assurance (QA) reports. Communicates results of Revenue Cycle QA audits to management and ensures issues are addressed and RCM processes are updated accordingly.
  • Collaborates with Medicaid eligibility vendor; oversees the eligibility process to ensure timely account resolution is met; audits and approves the monthly Medicaid eligibility vendor invoices.
  • Ensures that hospice, home health and authorization procedures are followed. Audits and approves monthly hospice nursing home room and board invoices.
  • Assists in third party payor and/or governmental audits.
  • Identifies opportunities for process improvements and/or automation and implements new procedures.
  • Participates in Revenue Cycle month-end close process.
  • Oversees performance to Revenue Cycle QA plan and department's KPIs, policies, and procedures. Compiles, analyzes and presents verification/authorization performance metrics to management.
  • Oversees system administrative support for multiple revenue cycle vendors/EHR.
  • Oversees the submission, tracking and resolution of system related issues.
  • Performs other duties as assigned.


This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.