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Clinical Revenue Supervisor
4 months ago
Department
BSD UCP - Revenue Cycle - Accounts Receivable Non Government
About the Department
The University of Chicago Practice Plan (UCPP) is the central organization that supports the clinical activity of nearly 750 clinically active faculty practicing at the University of Chicago. These clinically active faculty collectively form the University of Chicago Physicians Group (UCPG) which is located in Burr Ridge, IL. The University of Chicago Physicians' Group (UCPG) is a component of the physician practice plan for the University of Chicago. The UCPG department provides billing services for medical services provided by University physicians and manages the accounts receivable and reporting processes for the Biological Sciences Division (BSD) departments. Each physician is a faculty member and is based in a specified department in the BSD. The University of Chicago is a private institution encompassing the undergraduate College, six professional schools (Business, Law, Divinity, Public Policy, Medicine and Social Service Administration), four graduate divisions (Biological Sciences, Humanities, Physical Sciences, and Social Sciences) and the University of Chicago Medical Center. The broader University enterprise includes Argonne National Laboratory, Fermilab, and Yerkes Observatory. The Biological Sciences Division (BSD) includes the Pritzker School of Medicine, approximately 20 academic units, degree granting committees, and research centers and institutes. The BSD is located on the University's main campus in Hyde Park, ten minutes south of downtown Chicago. BSD's patient care operations are conducted primarily at the University of Chicago Hospital and clinics, which share the same campus.
Job Summary
The Analyst of DCAM AR will support the Manager of DCAM for the oversight physician claims billed through our hospital outpatient clinics. These role will have oversight of the effective operations of claim submission, no response, denial follow-up, appeals, and payer relations/escalation. This role will have a combination of internal and external staff reporting to them. They will supervise the daily activities of this operations team. Sets priorities for the team to ensure tasks are completes and coordinates work activities with other supervisors. Through this work they will solve complex problems related to revenue cycle operations as well as ensure successful billing, collection, and compliance activities within the department.
**Responsibilities**:
- Oversees the AR follow-up and denial resolution process with mínimal direct oversight.- Proactively reviews current workflows for AR resolution with the intention to improve, implement, communicate and maintain an efficient AR resolution process.- Identifies and resolves the systematic and/or operational root causes of denials and outstanding AR.- Oversees and manages the AR follow-up work queues (WQ) and proposes both short and long-term enhancements that support business needs.- Assists manager with maintaining payer scorecards, creating payer meeting agendas, and communicating issues to provider representatives.- Works with the payers on escalated account resolution, identifies and submits high-complexity and other escalated payer projects.- Creates simple to moderately-complex reports that are necessary for payor projects using a variety of business tools.- Proactively reviews payer communication, initiates payer policy and rule change implementation, and proposes changes to front-end or back-end edits.- Communicates clearly and professionally with the other UCPG units, clinical departments, external vendors, and payers in effort to build partnerships that result in denial resolution and prevention.- Provides AR follow-up expertise to other UCPG and UCM business units as needed.- Works closely with the Coding Education team to suggest opportunities for coder and provider training.- Assists clinical departments in resolving escalated AR and denial issues.-
- Provides AR follow-up training to existing and new AR follow-up staff.- Completes quality audits for denial and AR resolution activities.- Creates denial Appeal, Reconsideration, and Letter of Medical Necessity Letter templates and trains staff in effectively using these templates.- Creates workflows and assists manager in developing and documenting policies and procedures.- Provides support to UCPG and external entities for any AR issues.- Provides root cause analysis of AR issues and denials and implements tools and solutions to reduce denials and other manual AR follow-up work.- Provides direct support to AR resolution in effort to better identify trends and new issues.- Assists the manager in monitoring and trending AR and denials, provides root-cause analysis, assists in root cause resolution and identifies opportunities to improve workflows.- Supervises the day-to-day activities of the Clinical Revenue support staff.- Prepares departmental compliance efforts by participating in training
