Supervisor of Professional Follow-Up and Denials Hybrid

7 days ago

Providence, Rhode Island, United States LifeSpan Full time
Job Summary

The Supervisor of Professional Follow-Up and Denials Hybrid will oversee the day-to-day operations of the PFS team, ensuring timely and effective follow-up on claims activities. This role requires strong leadership and analytical skills to manage a team of up to 25 personnel and maintain compliance with Federal and State regulations.

Key Responsibilities
  • Provide direction and guidance to the PFS team in implementing approved follow-up procedures.
  • Ensure all procedures are in compliance with applicable regulations and initiate requests for system updates as needed.
  • Plan and supervise the effective utilization of resources, including staff, financial, material, and equipment.
  • Identify training needs through observation, audits, and productivity reports, and develop action plans to address these needs.
  • Function as a key resource to staff in resolving complex issues and assign work to ensure equitable distribution.
  • Maintain issues logs for individual payers and meet with internal and external representatives to discuss and resolve claim and denial issues.
  • Monitor payer contracts and identify, communicate, and resolve claims adjudication issues.
  • Authorize adjustments in accordance with department policy and ensure staff is apprised of changes in policy and procedures.
  • Maintain up-to-date knowledge of changes in regulations that impact claims administration activities.
Requirements
  • High school graduate with knowledge of medical business office practices, human resource management/training, and proficient in medical systems.
  • Demonstrated knowledge of third-party healthcare reimbursement regulations and ability to think critically with strong analytical skills.
  • Three to five years of supervisory experience preferred, with experience with various payers and knowledge in the use of software applications, databases, and spreadsheets.
Work Environment and Physical Requirements

Work is performed in a typical office setting requiring extensive sitting. Position requires ability to speak, see, and hear within normal range.

Independent Action

Functions independently within Lifespan's policies and practices, with the ability to work independently to achieve goals, objectives, and productivity requirements.

Supervisory Responsibility

Direct supervision for up to 25 full-time equivalent personnel.

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