Denials And Appeals PFS Supervisor

Responsibilities

• Monitor daily workflow, manage inventory levels, and ensure cases are resolved within mandated regulatory and/or payer contracted timeframes (e.g., Medicare Advantage, CMS, DOH).
• Review A/R analysis and all high dollar accounts with balances greater than $25,000; document the review in the account notes.
• Monitor denied losses for PFS.
• Identify challenges/barriers to timely filing and implement change needed to minimize timely filing denials.
• Distributes productivity and denial reports by status code to team members and PFS Leadership.
• Assigns and prioritizes work, sets goals, and coordinates daily activities of the team.
• Recruit, train, coach, and supervise appeal specialists and other team members, setting productivity and quality goals.
• Ensures unpaid/lengthy appeals are escalated to the Department of Insurance, CMS or Delaware Medicaid program as appropriate per PFS Leadership expectations.
• Provides regular updates and communication to staff through 1:1 and team meetings.
• Analyzes all denials trends, identifies root causes, develops corrective action plans and improvements for revenue cycle functions.
• Ensures denial reporting tool is current on all data files and team members are using the tool to enable accurate analysis and reporting in real time and at month end.
• Review appeals for accuracy, maintain audit readiness for state/federal audits, and update policies, procedures, and desktop manuals.
• Complete monthly rounding on direct reports; maintain individual rounding logs and stop light reports to facilitate communication.
• Serve as a subject matter expert, partnering with internal departments (e.g., Provider Relations, Legal, Utilization Management) and external entities, such as insurance carriers.
• Monitor performance by outside contractor within Bayhealth's performance expectations.
• Reviews quality assurance review results with staff providing as necessary education/training to address opportunities for improvement.
• Contributes to development of education materials for new hire and annual training competencies.
• Perform quality assurance in absence of department trainer.
• Reviews all requests for system changes to determine the impact on payers and processes under the position's span of control.
• Achieves supporting research and documentation supporting the change request are accurate and have been properly validated.

Qualifications

Required: Five years of hospital A/R or patient accounting experience at Bayhealth.

Preferred: Lead or Supervisory experience.

Skills

Knowledge of hospital financial systems and processes.

Ability to manage multiple tasks and prioritize effectively.

Strong analytical skills to identify and resolve complex issues.

Excellent communication and interpersonal skills.

Ability to work independently and as part of a team.

Proficiency in Microsoft Office Suite.

Understanding of regulatory requirements and compliance.

Basic knowledge of coding and billing practices.

Ability to work flexible hours, including evenings and weekends.

Benefits

Generous Paid Time Off and Paid Holidays

Matching 401(k)/403(b) Plans

Excellent Health, Dental, and Vision Insurance

Disability and Life Insurance options

On Site Child Care

Health Care and Dependent Care Flexible Spending Accounts

Voluntary Benefits to include Critical Care Coverage and more!