Supervisor Follow-up Insurance

Job Description

ECU Health

About ECU Health

ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary

Coordinates and directs the daily activities of the Insurance Representatives responsible for follow-up on billed claims for ECU Health hospitals and SSOP.

Determines professional learning needs of staff and identifies short/long-term goals relevant to position.

Reviews and evaluates daily ATB's, workstations and ADHOC reports to ensure adequate and timely follow up is performed and the workload is equally distributed.

Reviews and approves contractual, administrative and legally unbillable adjustments in accordance with the policy.

Stays current on all of the contractual agreements with third party payers and the affects on claim filing/contract management as it applies to each ECU Health hospital and SSOP. Liaison for Managed Care reimbursement resolution.

Responsible for hiring, training, scheduling, performance evaluations and time and attendance.

Stays current on the federal, state & local government regulations and the affects on claim filing.

Performs other related responsibilities as required or requested.

Responsibilities

Ensures that the policies and procedures pertaining to patient accounting are being followed in order to effectively reduce the accounts receivable in a timely manner to ensure overall profitability of the office.

Coaches and develops staff by continually monitoring the learning needs of each staff member and matching the skill set of each employee to the needs of the department.  Supervisor will also be responsible for identifying short-term as well as long-term goals.

Reviews and approves contractual, administrative and legally unbillable adjustments based on third party payer regulations.  All adjustments are made in accordance with established policies.

Analyzes Contract Management System underpayment reports and delegates accounts to the appropriate Representatives to follow up with the payers. Acts as liaison for resolution of contracted payer reimbursement issues. Managed Care assistance will be obtained if needed.

Screens, interviews and hires applicants.  Assist new employees in their training and development.  Responsible for the monitoring and performance evaluations of employees.  Reviews scheduling and approves time and attendance.

Performs in accordance with accepted procedure and responds to special requests by management in a timely and accurate manner.
Adheres to the policies and procedures. Uses tact and courtesy in all interactions including but not limited to staff, patients and payers. Promotes a positive image and supports management in goals and objectives. Handles inquiries and complaints discreetly and effectively.

Evaluates and ensures that adequate and timely follow-up on accounts is being performed by each Insurance Representative for each ECU Health hospital and SSOP.  Accounts greater than 120 days must be individually reviewed by the supervisor to ensure proper follow up and documentation has been done.  Appropriate adjustments will be made to the workload when needed.

Reviews, analyzes, and communicates bulletins with the appropriate people to ensure there is no negative impact on reimbursement for all ECU Health hospitals and SSOP.  Workshops and other meetings are attended to assist in keeping abreast of changes.

Minimum Requirements

• High School or higher required with 2 additional years formal education.
• 4 years experience - Third party billing and reimbursement, insurance carriers, on the job training, accounting, or related can be substituted for additional education.

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.