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Denials and Appeals Supervisor in Los Angeles, CA at TeamHealth

Date Posted: 3/21/2019

Job Snapshot

Job Description

JOB DESCRIPTION OVERVIEW:

Supervise and manage the Denials and Appeals Department at the Billing Center. Manage daily workflow and ensures the department meets or exceeds standards for quality, production, and performance. The Supervisor is also responsible for staffing, disciplinary action, training, and enforcing adherence to established policies and procedures. The Supervisor ensures assigned employees are trained and consistently follow all Team Health policies and procedures including applicable HIPPAA and Compliance Policies. The Supervisor is accountable for quality assurance of all functions in the department.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Plans, organizes, monitors and directs the processing of the resolution of claim denials
  • Analyzes system data and denial reports to identify issues with existing processes and make recommendations to initiate processes improvement
  • Consults with AR Manager to prioritize the working of denials and maintains current denials and appeals to meet Team Health Standards
  • Evaluates carrier requirements and formulates a denials resolution strategy
  • Defines and implements a program for quality assurance for assigned areas
  • Actively participates in the training/retraining of employees, especially working with new hires in the initial onboarding process
  • Supervises and maintains Denials and Appeals Representatives in working denials including productivity and quality of work
  • Maintains accurate production and quality records
  • Monitors key performance indicators and metrics for the department providing corrective action as indicated
  • Completes employee performance appraisals and administers disciplinary action where appropriate
  • Maintains accurate records of disciplinary actions, developmental conversations, and employee training sessions for their area
  • Manages and assigns work of team members, maintains effective personnel relations and ensures that goals are achieved timely to ensure system operated efficiently
  • Develops long-range and short-range goals and objectives
  • Compiles and communicates issues for management intervention and works on issue resolution made by employees with the assistance of Human Resources and Manager/Director
  • Actively participates in the leadership of the department and motivating staff
  • Strives to improve internal relationships between internal departments.
  • Works with other denials supervisors to improve the denials resolution processes across Billing Centers
  • Evaluates and refines systems to provide the most efficient, cost effective, and workable flow of reimbursement and accounts receivable management practices
  • Manages department within budget guidelines, preparing and monitoring annual budgets
  • Processes RAC Audit requests
  • Reviews specific edits listed on the Unbilled Charges Report
  • Reviews and analyzes specific rejection codes listed on the Denied Invoices Pending Report
  • Assists with research and development of appropriate denial procedures
  • Creates and maintains policies consistent with HCFS and Team Health policies
  • Updates and submits for approval policies and procedures for department
  • Review, schedule, manage and approve work schedules and maintain timekeeping information
  • Responsible for ensuring accurate and timely processing of bi-weekly timecards
  • Controlling inventory, supplies, and materials necessary for the function of the department
  • Understands Team Health compliance plan and HIPPA regulations.
  • Informs appropriate Manager(s), Director(s), VP(s) or Corporate when obvious inappropriate business practices are evident that may affect not only reimbursement and accounts receivable management, but also relationships with clients, hospitals, payers and legal status including any noted compliance or HIPPA concerns
  • Proactively keeps the Manager/Director/Vice President updated on the status of workload and any potential problems that may arise
  • Performs and assist with other duties as assigned by the Accounts Receivable Manager/Director/Vice President
  • Assure the safety of employees

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • Excellent knowledge of healthcare payer reimbursement for physician billing
  • Prior experience in managing denials resolution
  • Good communication and interpersonal skills
  • Knowledge of ICD-9 and CPT-4 coding
  • Good team management skills
  • Good analytical skills
  • Good knowledge of Excel
  • Proficiency in working with systems (IDX experience is desirable)
  • Computer literate
  • Excellent follow-up skills
  • Excellent organizational skills
  • At least (3) three years as a Senior/Lead and preferable five years total physician billing experience with specifically two years’ experience in Denials and Appeals or A/R Management.
  • Set in a high-volume, fast-paced office environment. Involves extensive computer use.
  • Overtime may be required and can be mandated by Management.
  • Occasional travel to seminar or training sessions may be required.

SUPERVISORY RESPONSIBILITIES:

  • The Supervisor is responsible for overall, day-to-day management of the department.
  • Manages Denials and Appeals Senior

PHYSICAL / ENVIRONMENTAL DEMANDS 

  • Job performed in a well-lighted, modern office setting
  • Occasional standing/bending
  • Occasional lifting/carrying (20lbs or less)
  • Moderate stress
  • Prolonged sitting
  • Prolonged work on a PC/computer
  • Prolonged telephone work

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.

DISCLAIMER:

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.

 

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