Healthcare Insurance Billing Supervisor

2 weeks ago

Pasig, National Capital Region, Philippines Visaya Knowledge Process Outsourcing Corp Full time

Responsibilities:

• Oversee and supervise the daily Hospital Billing operations, workflows, and colleague performance.
• Serve as a technical expert of billing and billing scrubber technology.
• Establish team and individual goals and priorities concurrent with organizational objectives.
• Monitor staff performance and quality, addressing any training or performance issues.
• Conduct daily and weekly staff meetings for continued process improvement and project knowledge.
• Conduct routine account activity quality audits to ensure accounts are being worked appropriately.
• Collaborate with leadership and training to build training plans required to build a best practice team.
• Assist and resolve internal business partner inquiries.
• Compile and provide reports or logs to leadership for regular review.
• Maintain a current working knowledge of all healthcare-related issues and regulations.
• Proactively analyze and solve problems quickly and thoroughly.
• Report trends and potential issues to leadership as appropriate.
• In coordination with Human Resources, make decisions related to corrective actions, hiring and terminations.
• Review and manage team timecard verification and requests for time off, ensuring alignment with business needs and staffing requirements.
• Perform special projects as required.

Additional Expectations:

• The Billing Supervisor would have their own work queue.
• When the billers do the adjustments, they go into a separate supervisor manager work queue and they have to be approved by that supervisor.
• The supervisor would have to look at the note and check why did they take the adjustment? Do they agree to the adjustment or do they not? They'll sign off on it and then they approve the adjustment.
• For over $500, they all have to go through the supervisor to make the adjustment.
• Some of the other roles of the current billing supervisor include working all of the embassy claims, any of the international claims.
• The other roles by the billers are rejections.
• The billers work all of the claim edits and all the rejections.
• These are claims that went out to our payer clearing house which is Availity.
• They came back in and rejected by the payer.
• So if it's a smart edit and it needs to be transferred to coding they would do that; if it's an attachment they would add that; if it's a provider they would transfer to the provider.
• The billing supervisor has to know how to do all those things as well and be able to do them.
• The expectation of the current billing supervisor is when one of the billers is out, that billing supervisor steps into that role for the day.
• The billing supervisor is able to work all of the claim edits, all of the rejections, etc. Just like one of the billers.
• The billing supervisor would need to keep up with the productivity and the QA.
• The quality audits of the billing team, the current billing.
• The billing supervisor comes to all of the payer meetings.
• All of Medicaid, MCO's which is the managed care, it's the Medicaid managed care contracts.
• Biweekly monthly meetings.
• The billing supervisor attends those and they go over any edits that they see.
• The other biggest, biggest thing is when an external edit, which is of Clearing House Edit, which is a payer edit, when it comes back the client asks the billing supervisor, since they're the first ones to see these, the client needs to know when they hit because they want to make an Epic edit.
• Client doesn't want external edits and would rather have them all us, so we try to prevent these.
• Make sure we go out with clean claims.
• The billing supervisor is hands-on in the work queue.
• The billing supervisor is the client's first line of sight through all of the claims and they have a 98% expectation of clean claim rates.
• The billing supervisor currently works with the payer clearing house more than any on the client side.
• The clearing house being Availity.
• They put in the tickets if. anything is wrong with the claims.
• If the claims don't go out any of those things, the billing supervisor is the first line of sight before any of the claims hit.
• Huge bonus points if the person has experience on Availity, which is the clearing house and/or Epic experience.

Qualifications:

• High School Diploma or GED
• 2+ years of experience in healthcare insurance billing with or for a hospital or hospital system, working directly with government or commercial insurance payers
• 2+ years working knowledge of Billing scrubbers' processes and functionality
• Demonstrated ability to work in a team environment that requires quick turnaround and quality output
• Ability to facilitate and influence decisions by motivating others to achieve excellence
• Demonstrated subject matter expertise in insurance company practices regarding reimbursement with the ability to translate knowledge into training, supporting performance excellence
• Ability to develop and manage relationships with colleagues
• Demonstrated ability to navigate Internet Explorer and Microsoft Office
• Proven knowledge and experience in governmental, legal, and regulatory provisions related to billing and collection activity
• Must be willing to work onsite in Ortigas, Pasig City.

Preferred Qualifications:

• BA/BS in business, healthcare administration or related concentration
• AAHAM (American Association of Healthcare Administrative Management) Certification
• Prior management or supervisory experience
• Green Belt Process Improvement Certification

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