Appeals Supervisor

About the Role

The Appeals Supervisor provides leadership and guidance to the Appeals No Activity role in the No Activity workflow and the following two roles within the Rejections Workflow: Appeals and Charge Corrections.

• Appeals No Activity role: Reviews invoices that have previously been appealed but no response has been received.
• Appeals role: Reviews invoices based on rejection code to determine if an appeal is required.
• Charge Correction role: Performs charge corrections on applicable invoices transferred from the Coding department.

The Supervisor monitors, delegates, and researches daily productivity of assigned staff, analyzes the A/R, and identifies billing issues that could prevent untimely or delayed adjudication of claims. Plans processes for resolutions of A/R billing and collection problems, makes recommendations, and communicates with other department supervisors to maximize reimbursements and minimize delays in adjudication of medical claims.

Responsibilities

• Reviews weekly ETM PIT Reports to ensure worklists are being processed and maintained per department standards.
• Ensures all invoices by reporting category and division are being assigned properly.
• Reports to A/R Manager on the status of workload for the department.
• Reviews staff productivity and maintains quality assurance policy and procedure guidelines.
• Manages department within budget guidelines.
• Processes RAC Audit requests.
• Reviews assigned edits listed on the Unbilled Charges Report.
• Recruits, hires, trains, leads, and motivates staff.
• Completes employee performance reviews.
• Maintains current and up-to-date technical competence in physician fee-for-service and managed care billing and insurance reimbursement.
• Manages staff and procedures ensuring systems operate efficiently and effective personnel relations are maintained.
• Disseminates timely billing communications to staff.
• Informs appropriate supervisors when obvious inappropriate business practices are evident, which may affect reimbursement, accounts receivable management, and relationships with clients, hospital, and insurance payers.
• Completes special projects and reports as requested by the A/R Manager.
• Maintains a personal work schedule that allows regular and dependable attendance.
• Complies with mandatory overtime requirements at the direction of the A/R Manager.
• Assumes other duties as assigned by A/R Manager and Assistant Vice President of A/R.
• Communicates with the AVP and Manager regarding the timely progress of projects and assignments.
• Reports on any problems, detected errors, and/or changes to the Manager.
• Creates and maintains policies consistent with HCFS and Team Health policies.
• Participates in monthly progress meetings with staff regarding Accounts Receivable and system processes.

Requirements

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

Supervisory Responsibilities

Manages Appeals Representatives and Senior staff.

Schedule

Full-Time