Coordinates all Insurance follow up and/or Payment Applications in the Business Office. Assesses the work performance of assigned employees and interacts in a professional manner with patients, companies, payers, physicians and other CH personnel. Must provide accurate statistical records and reports. Proactive in problem solving and works to ensure quality performance of business functions throughout the organization.
1. Hires, trains and supervises employees engaged in the day-to-day operations of the Insurance and/or Payment department of the Business Office.
2. Provides orientation and training on billing and/or related information.
3. Oversees the implementation of new department procedures as required to ensure maximum department efficiency.
4. Holds regular department meetings to keep employees abreast of new organizational policies and department procedures.
5. Develops departmental budget, goals and strategies to attain such goals.
6. Ensures CH is compliant with billing and coding requirements dictated by government regulations.
7. Keeps abreast of legislation and regulations affecting reimbursement. Develops methods to effectively communicate and introduce required changes to billing processes and staff.
8. Completes timely annual performance evaluations for department staff members to include individual staff goals and strategies to attain such goals.
9. Provides disciplinary action, as needed, for department employees. Works with the Human Resources department and Director through all termination procedures.
10. Attends and participates in regular Manager's meetings.
11. Actively participates with Epic module conversions/upgrades as they affect coding and billing requirements.
12. Participates and/or chairs CH committees or task forces as needed or requested.
13. Performs other tasks as requested by Leadership.
14. Develops policies and procedures pertinent to department and auditing processes. Makes appropriate changes as needed.
15. Maintains monthly reports of the organization's A/R and of the performance of each area of the department.
16. Addresses specific concerns (i.e., payment challenges, denials, etc.) with payers as needed. Maintains productive working relationship with each payer.
17. Monitors department and individual workflow and assists where needed to ensure maximum efficiency. Adjusts workflow as warranted.
18. Oversees time management of Business Office staff to ensure overtime is kept to a minimum. Monitors overtime needs and approves requests as required.
19. Ensures teamwork efforts are constant departmentally and interdepartmentally. Addresses non-compliance as needed.
20. Approves all adjustment write off requests over $500.
21. Participates with committees or work groups outside of the Organization that benefit the medical center as a whole.
· Bachelor's degree required.
· 2 years of relevant leadership experience required.
· Current Confluence Health employees may substitute a Bachelor's degree with an Associate's degree and 6 years of relevant experience, 2 of which must be leadership, and completion of a Bachelor's degree within 2 years of hire; OR LEAD completion.
· Proficient in the performance of basic math functions.
· Possesses excellent business writing and computer (e.g., spreadsheets, word processing) skills.
· Knowledge of ICD, CPT coding, medical terminology, and insurance billing a must.
· Must be a team player.
· Maintains a positive, resourceful attitude toward achieving overall department and clinic goals.
· Must maintain primary residence in the Confluence Health service area.
· Master's degree.
· Related professional certification preferred.