PURPOSE AND SCOPE: Manages the day to day operations of a verification team within a FMS Billing Group contributing to the timely and accurate processing of the Accounts Receivable billing and collections functions by monitoring the team activities to ensure all patient insurance information is up-to-date and accurate. Works closely with appropriate clinical, regional and divisional staff and/or management to resolve escalated issues as needed. Implements initiatives and strategies pertinent to the verifications process as directed. Provides subject matter expertise, support and guidance to direct reports ensuring department goals and objectives are met. Supports FMCNA's mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements. DUTIES / ACTIVITIES : CUSTOMER SERVICE: Responsible for driving the FMS culture through values and customer service standards.Accountable for outstanding customer service to all external and internal customers.Develops and maintains effective relationships through effective and timely communication.Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner. PRINCIPAL RESPONSIBILITIES AND DUTIES: Supervises, directs and develops a Billing Group verification team including Senior Patient Account Representatives (Senior PARs) and Patient Account Representatives (PARs) providing expertise, advice and support as needed and ensuring they are properly trained and motivated towards meeting department goals and objectives.Assigns, monitors and prioritizes verification related tasks and workflows and the coordination of special projects ensuring Senior PARs and PARs perform all daily/weekly/monthly activity accurately and within the defined timelines as required according to standard policies and procedures.Works closely with PARs, Sr. PARs, billing group personnel, facility staff and patients as needed to promptly resolve complex insurance verification related issues in order to help ensure the timely and accurate processing of the Accounts Receivable billing and collections function. Escalates issues to upper management per Division policies as needed.Oversees the insurance verification and insurance entry process ensuring tasks are being performed accurately and according to department policies and procedures in order to consistently guarantee proper patient billing. Audits patient accounts to ensure follow-up activity has been assigned for open insurance related items in order to avoid delays in the admissions or billing process.Monitors and reviews the following worklists and activity within the eCube Financial's system on a daily basis ensuring PARs and Sr. PARS are completing necessary functions as needed and worklists are up to date. Assists with the resolution of any pending issues or discrepancies as needed. Encounter Insurance Verification Work List for pending verifications. Encounters with Incomplete Insurance Work List. Missing Patient Information Work List to identify and resolve Encounters with missing patient information after the patient begins treatment.Missing Guarantor Information Work List to identify and resolve Encounters with missing guarantor information after the patient begins treatment.Unviewed Eligibility Responses Work List to ensure that all information received via an electronic insurance verification is reviewed and updated in eCube Financial's as applicable.Encounters with Missing Information by Start Date Work List.Ensures appropriate and timely follow up is completed by staff members on missing Assignment of Benefits and Medicare Secondary Payer questionnaires in order to avoid billing delays. Monitors the proper documentation of receipt within eCube Financial's. Monitors insurance updates and follow-up activities of patient accounts within eCube Financial's ensuring appropriate internal controls, timeliness and accuracy are maintained. Assigns late or overlooked updates as needed. Updates include:Patient insurance information within eCube Financial's ensuring details are current and up to date. Insurance and effective dates for approved Indigent Waivers.Current or retroactive changes to insurance based on notifications of changes and terminations as confirmed by Insurance Verification. Authorizations/pre-certifications, including renewals are up to date. Communicates the Coordination of Benefits period to department staff ensuring insurance changes are made timely.Oversees, reviews and approves the monthly close process ensuring insurance information is accurate, submitted timely and complies with corporate reporting requirements. Provides day to day guidance, support and direction to the verification PARs and Senior PARs. Provides informal feedback on an ongoing basis and formal feedback in the form of annual performance evaluations. Supervises the department staff through the appropriate hiring, firing and disciplinary actions.Recommends process improvements as needed in an attempt to increase accuracy and reduce delays or errors in the insurance verification, billing or admission process. Facilitates open communication and coordination between groups to improve insurance verification and billing efforts, address questions/issues and ensure consistency.Other duties and projects as assigned. PHYSICAL DEMANDS AND WORKING CONDITIONS: The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. EDUCATION: Bachelors or Associates Degree preferredHigh School Diploma required. EXPERIENCE AND REQUIRED SKILLS: 5 years healthcare billing or collections experience with Bachelors Degree or8 years healthcare billing or collections experience with Associates Degree or10 years healthcare billing or collections experience with High School DiplomaWorking knowledge of Windows-based software applications (i.e., Word, Excel).Ability to analyze data.Ability to coach and lead others and develop their knowledge and skills.Excellent written and verbal communication skills. Good interpersonal skills and team oriented. Well organized and detail oriented.Positive attitude, enthusiastic and energetic.EO/AA Employer: Minorities/Females/Veterans/Disabled
* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.