Supervises the daily workflow of the department, monitoring progress to identify trends in denied payments by insurance companies, determining trends in unpaid claims and remediation solutions.
Reviews Leadership No Touch Report if available to ensure all high dollar accounts are reviewed monthly.
Reviews action logs daily and completed action logs pending to be verified.
Conducts team huddles to efficiently cover new or evolving training focuses to encourage and develop team members, including sharing identified trends and solutions on unpaid and denied claims.
Leads Team DIBS meetings and provides recap to team and leaders.
Ensures adherence to the departmental budget, including overtime.
Prepare monthly reports as requested.
Establishes departmental goals with the staff to optimize performance and meet budgetary goals while improving operations to increase customer satisfaction and meet financial goals of the organization.
Ensure all team members meet productivity and quality standards.
Meets with all associates 1:1 monthly to review current performance.
Maintains and communicates any associate behavior, performance and attendance issues that may constitute a verbal or a correction action and/or performance improvement plan.
Ensures timely completion and documents conversations in Workday.
Reviews assigned associate's time management and approve timecards for payroll processing in a timely manner.
Reviews Roster in Workday to ensure correct client, cost center and work location assignment.
Collects, interprets, and communicates performance data using various tools and systems, while also using this data to make decisions on how to achieve performance goals.
Works with internal and external customers to make key decisions, impacting either the organization or an individual patient.
Works closely with ancillary departments to establish and maintain positive relations to ensure revenue cycle goals are achieved.
Requirements
1 to 3 years of relevant experience in medical collections, physician/hospital operations, AR Follow-up, denials & appeals, compliance, provider relations or professional billing preferred.
Knowledge of claims review and analysis.
Working knowledge of revenue cycle.
Experience working the DDE Medicare system and using payer websites to investigate claim statuses.
Working knowledge of medical terminology and/or insurance claim terminology.
Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI.
Ensemble Required License: CRCR, either upon hire or within 9 months of hire. (Or other approved job relevant certification, as approved by SVP of department.)