Supv Claim Analytics

About the role

Supervises the assigned functional area of billing-related operations with a primary focus on ensuring timely, accurate, compliant, and efficient processing of claims to receive appropriate reimbursement and reduce accounts receivables in compliance with Generally Accepted Accounting Principles (GAAP) to ensure protection of cash assets. Responsible for operating within budget limitations and authorized staffing levels.

Responsibilities

• Assesses employee training needs and coordinates with the training department to ensure appropriate development.
• Initiates and implements improvements to billing systems and processes, including pursuing and developing improved techniques and ensuring quality.
• Ensures compliance with all federal, state, and local regulations regarding billing and claims; maintains up-to-date knowledge of changes in healthcare billing regulations and implements necessary changes within the department.
• Functions as a liaison with providers, external departments related to the revenue cycle, and insurance payors to resolve discrepancies, minimize receivables, and limit bad debt expenses.
• Initiates and implements improvements to billing systems within the confines of federal and state collection laws and third-party payer requirements with respect to health coverage and reimbursement.
• Conducts ongoing evaluation of department policies and procedures to maintain and improve department efficiency and performance.
• Adheres to productivity and quality standards of the department and reinforces those standards with team members.
• Performs human resources responsibilities for staff, including coaching on performance, completing performance reviews, and overall team member morale and engagement.
• Recommends team members for hiring, compensation changes, promotions, corrective actions, and terminations.
• Ensures personal actions and the actions of supervised team members comply with the Advocate Aurora Health Care Code of Ethical Conduct and applicable policies, regulations, and laws.

Requirements

• High School Graduate (required).
• 3–5 years of experience in healthcare.
• 3–5 years of experience in patient accounts, medical billing, or collections within a healthcare setting, including billing procedures for various types of payers (private insurance, Medicare, Medicaid, and self-pay patients).
• 3–5 years of supervisory experience in a billing or accounts receivable department with a proven ability to manage a team, including training, mentoring, and performance management.
• Experience with healthcare regulations, such as HIPAA, and understanding compliance requirements in billing and collections.
• Hands-on experience with patient billing software and electronic health records (EHR) systems.

Skills

• PC skills in Microsoft Word, Excel, PowerPoint, and Teams.
• Previous experience leading a patient accounting team.
• Strong oral and written communication skills to train and supervise staff and to communicate effectively and collaboratively with other department supervisors, external organizations, and top management.
• Ability to effectively address difficult and controversial issues.
• Excellent organizational, analytical, and problem-solving skills.
• Demonstrated proficiency, knowledge, and understanding of regulations of revenue cycle processes and healthcare patient accounting practices and procedures.
• Demonstrated ability to manage multiple projects simultaneously and supervise patient accounting functions.
• Demonstrated ability to develop and implement procedural and quality improvements within patient accounting environments.
• General knowledge of business, finance, human management, and operations.

Schedule

This position is remote but may require travel, exposing the role to weather and road conditions.

Physical Requirements and Working Conditions

• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment.