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Overprovisions/ Refunds Lead in Los Angeles, CA at TeamHealth

Date Posted: 7/15/2019

Job Snapshot

Job Description

JOB DESCRIPTION OVERVIEW:

Under general supervision the Over Provisions Senior is responsible for all functions necessary for the production of refunds. This includes overseeing distribution of credit balance reports and maintaining target dates for refund production according to TeamHealth policy. The Overprovisions senior is directly responsible for performing Quality Assurance (QA), staff development and training, escalated issues/concerns from our customers (internal and external), remedial training, and other duties as requested. Other duties include but are not limited to, monitoring production, daily refund approvals, and distributing mail evenly to the staff.The senior must provide support to overprovisions representatives on questions and inquiries, have working knowledge of Federal and State privacy regulations, and have excellent problem solving skills. The position works in a cooperative team environment to provide value to customers (internal or external). The Overprovisions Senior carries out his/her duties by adhering to the highest standards of ethical and moral conduct, and acts in the best interest of TeamHealth. This individual exercises independent judgment in key decision-making processes.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Quality Assurance
  • Provide training, coaching, mentoring, and support to Patient Accounts Representatives
  • Provides statistical and performance feedback weekly to each team member.
  • Providing daily direction and communication to employees as necessary
  • Creates and maintains a high-quality work environment so team members are motivated to perform at their highest level
  • Ability to timely and accurately respond to requests (email, phone, etc.)
  • Is able to work well under pressure, balance work volumes, identify trends, and ensures compliance with performance metrics and TeamHealth policies.
  • Ensures department is currents and meets departmental performance indicators/goals
  • Ensures compliance with state and federal laws and regulations for Commercial, Medicare, Medicaid, Managed Care and self-pay payers.
  • Approve all refunds up to threshold
  • Prepare refunds above threshold for manager or above approval
  • Participates in a process to continually improve organizational effectiveness using self-assessment performance evaluation criteria.
  • May perform special assignments and other related tasks as assigned.
  • May perform a follow up on outstanding AR in order to meet department’s performance goals.
  • Provides continual evaluation of processes and procedures. Responsible for suggesting methods to improve area operations, efficiency and service to both internal and external customers.
  • Provides feedback to supervisor regarding issues or possible process improvements
  • Communicates all employee relation issues to the manager and maintains a collaborative relationship with the manager
  • {Essential duties}

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • Minimum 3 years’ experience posting medical payments or overprovisions experience
  • Intermediate/Advanced knowledge of Microsoft Excel.
  • Knowledge of basic math and the ability to perform math functions in units of American currency.
  • Knowledge of GECB and GPMS posting process
  • Knowledge of GECB and GPMS functionality including BAR and ETM
  • Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form.
  • Ability to review documents for accuracy and reasonability.
  • Ability to determine priorities
  • Ability to coordinate schedules and information.
  • Ability to work well under pressure.
  • Tact and patience when dealing with individuals at all levels, both within and outside the company.
  • BS or BA preferred or equivalent of management/supervisory experience in physician billing related field preferred.
  • Some college coursework in business administration or accounting preferred.
  • Some supervisor experience is helpful

SUPERVISORY RESPONSIBILITIES:

  • This position does not have direct reports.
  • Under the direct supervision of the department Supervisor/Manager this position is responsible for monitoring and reviewing the work of the representatives within the department and providing recommendations to improve the quality and quantity of work done.

PHYSICAL / ENVIRONMENTAL DEMANDS:

  • This position may be relatively highly stressful with significant workload.
  • Requires physical and/or mental stamina to work additional hours beyond a regular schedule and/or more than five days per week.
  • Significant workload that may require after hours work and/or additional hours be mandated by Management.
  • Job performed in a well-lighted, modern office setting.
  • Regular and reliable attendance is necessary.
  • Ability to meet closing deadlines, and production standards is required.
  • Occasional standing/bending.
  • Occasional lifting/carrying (20lbs or less).
  • Prolonged sitting.
  • Prolonged work on a PC/computer and telephone.
  • 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.

 

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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