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Insurance/Claims/Collections Supervisor, Medi-care/Medi-caid
4 months ago
Under the direct supervision of the PBS Collections Manager, this position is responsible for the day to day operations of the Collection Department to ensure they are in compliance with organizational and industry standards. Supervises the collection team staff activities that promote best practices for collection efficiency and maximization of revenue. Supervises daily activities of the hourly staff to ensure maximum collection of all receivable revenue and miscellaneous revenue. Identifies quality issues, advises management and implements solutions. Builds an effective team by demonstrating team leadership, budget development and management, work plan development and project implementation skills. Creates strong customer service orientation and collaboration, results orientation and strategic thinking within the Collections unit.
Essential Responsibilities:
Provides overall supervision of the collections department, contributes and ensures accurate and timely collection of all appropriate revenue for PBS. Recruits and maintains a competent, motivated and qualified staff including disciplining, counseling, coaching, advising, training, termination and resolution of personnel issues. Conducts performance evaluations for staff. Monitors and measures collection performance against cash performance targets by collector, by payer category, by medical center and division, and maintains communication between the collections teams and service area PBS teams. Identifies and develops new products and services to enhance recoveries. Communicates updated procedures and information to all involved parties. Ensures effective financial management of Accounts Receivable, to include financial tracking and analysis of financial recoveries and performance. Plans and implements departmental programs and systems that provide analytical support on financial issues. Authorizes refunds, write offs and adjustments up to a specified amount.
Provides consulting expertise to business function areas and coordinates/conducts required training as identified from various sources or externally mandated requirements; stays abreast of all regulatory changes and requirements; implements and communicates changes to department and service area staff within PBS. Ensures timely and accurate processing of industrial, TPL, COB, commercial insurance, Medi-Cal, and outpatient Medicare and self pay accounts in accordance with best practices, defined process flows and procedures and applicable legislative and regulations. Ensures consistent application of processing procedures, policies and personnel practices among the employees on the collection team and promotes organization and division strategic objectives. Supervises the work of the staff in maintaining high quality of work with revenue enhancement and customer service focus, through monitoring operational performance, and implementation and improvement options for either/or Northern and Southern California. Ensures consistent application of divisional wide operational practices, policies and procedures. Develops, recommends, implements and monitors goals, objectives, and performance standards Tracks and analyzes financial recoveries of outside vendors, ensuring effective performance. Plans, develops, and implements administrative strategies consistent with business plans, organizational goals, health plan member service agreements and federal and state law. Ensures appropriate financial reporting and accounting of revenue. Ensures preparation of Northern and/or Southern California general accounting documents for monthly revenue and PBS financial reports. Resolves policy issues and in cooperation with Marketing and Sales, Regional Claims, Membership Accounting, Accounts Receivable, Legal and Members Services as needed. Responsible for payroll and non-payroll budgets for North and/or South cost centers. Coordinates the resolution of complaints with appropriate division and facilities personnel. Respond to complex issues relating to members, patients, insurance companies, attorneys, KP employees, and, if appropriate, follow-up with written response. Hires, disciplines and counsels and conducts performance evaluations for hourly staff.
Basic Qualifications:
Experience
Minimum three (3) years experience leading, managing or supervising staff, preferably in a healthcare environment.
Education
Bachelors degree required, OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
License, Certification, Registration
N/A
Additional Requirements:
Collection Management experience in a health care setting.
Familiarity with specific lines of business (e.g. billing, collections, governmental programs, etc).
Knowledge of applicable state and federal regulations related to billing and collections.
Knowledge in budgeting and accounting principles and of personnel/labor laws and regulations.
Knowledge of systems requirement development and user acceptance testing.
Excellent negotiating and analytical skills.
Demonstrated interpersonal skills in dealing with employees and all levels of management. User knowledge of word processing and spreadsheet software and mainframe systems.
Strong verbal and written communication skills and excellent presentation skills.
Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
Knowledge and understanding of the relationship between management and union contracts and work within the parameters of the Labor management partnership, preferred.
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