HEALTHCARE REIMBURSEMENT, COLLECTIONS, A/R HOTLINE MANAGER - Marietta, GA
Client company is a rapidly expanding Medical/BioTech company, providing outstanding career growth and promotional opportunities.
As a Reimbursement Hotline Supervisor able to answer questions as it relates to Medical Verifications of Insurance policies, coding, billlling & claims questions. Securing authorizations for Client company's products. Ensuring the Hotline team meets daily productivity goals set by management team. Mentoring/Counseling team members for efficiency. The position follows all necessary policies, procedures, processes and systems in place to support the maximum and most efficient reimbursement for client's products.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Responsible for Multi-shift supervision of team members, provide leadership & accountability to team of reimbursement specialist.
This is a working Supervisor position and we are looking for Agressive, Forward thinking and highly motifived leader who is very hands-on.
Managing inbound and outboand Cisco call volumes/schedules.
Leading a team of specialist to meet or exceed daily production goals, Quality Assurance of cases upon completion.
Coaching, providing feedback to and resolving conflicts amoung team members.
Identifying payer process, account process and communicating to team members, updating systems with new information as it relates to processes (Alfresco/Salesforce)
Completes Benefit and Prior Authorization Requests expediently and accurately to ensure payer reimbursement of client products. Proactively contacts the office/facility, Field Reimbursement Manager or Sales Executive if additional information is required to proceed with the case. Enters complete information accurately in the Salesforce/Alfresco system.
Takes Reimbursement Hotline calls and researches answers extensively to ensure the most accurate information is communicated to a physician's office, health plan and sales team.
Provides exceptional customer service to internal and external customers.
Multitasking while maintaining a high level of efficiency & organization.
Completes daily reports as assigned.
Follows HIPAA policies and procedures to ensure protected health information is secure and not accessible to employees not authorized to view the information.
Communicates procedures for physician office, hospital, outpatient facility and ambulatory care center billers to implement to ensure maximum efficiency and collection of their accounts receivable, including coding procedures and processes for denial and low payment appeals.
Adheres to the organization's appeal strategy and manages the on-going tactical application of the appeal strategy to ensure a successful reversal rate.
Provides the most effective communication to health plans to ensure maximum level of reimbursement approval.
Interacts with health plan personnel to educate and influence their decisions related to medical management recommendations for approval of reimbursement.
Builds rapport with physicians office and sales team.
SKILLS and COMPETENCIES
Job characteristics will require a flexible individual with high analytical skills and clinical interests.
Excellent communications and relationship skills are required. Excellent interpersonal and communication skills to deal effectively with all necessary levels within and outside of the organization.
Problem analysis and problem resolution at both a strategic and tactical level.
Strong organization skills and superior attention to detail. Stong decision maker.
Ability to gain high levels of credibility and excellent persuasion skills to achieve desired results.
Ability to combine strong tenacity with excellent diplomacy.
EDUCATION and EXPERIENCE
Seven (7) years of experience in health care collections, A/R management, insurance verification, appeals negotiations and processing, billing/claims processing, data processing, and software operations in the health care industry are required to meet the standards of this position.
Requires a comprehensive understanding of Medicare, Commercial and Medicaid health plans.
Extensive knowledge of medical coding including ICD9/10, CPT and HCPCS codes. AAPC certification a plus.
Ability to review medical records and verify patient medical criteria as cases are worked.
Ability to successfully interact with all levels of management, both internal and external, third party payers, and customers is essential. Excellent communication and organizational skills are essential for this position.
Comprehensive understanding of medical management and health insurance concepts, information systems and strong analytical and problem solving skills are required.
Demonstrated work experience applying PC based analytic tools to provide support to a health insurance or clinical process is required. (Microsoft Excel, Microsoft Word.)
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