Mgr, Claims Follow-up

Job Description

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

The Manager of Claims Follow-up will manage the resolution of professional and hospital insurance claims. Responsible for creating reports, analyzing data, identifying lost revenue, collecting payments, and implementing revenue cycle management strategies to minimize losses. Ensures claims are adjudicated timely and accurately.

The position executes decision-making to analyze claims exposure, plan the proper course of action, and appropriately resolve claims. Defines and provides necessary support to achieve department goals and objectives. Provides oversight and functions as it relates to managing professional and hospital claims follow-up, collections, and other matters related to accounts receivable.

Serves as a subject matter expert on contemporary best practices for revenue cycle workflows, team integration, and excellence in achieving goals.

Responsibilities

Essential Functions of Role:

1. Manages accounts receivable follow-up processes and workflows.

2. Understands, develops, implements, and analyzes key performance measures for continuous improvement. Identifies specific trends or issues and communicates status and resolution with leadership.

3. Monitor A/R effectively and ensure aging categories are within established goals and national benchmarks.

4. Manages resolution of claims with individual insurance carriers or agencies.

5. Maintain continual knowledge of payor policies to assure optimal reimbursement for all services performed within the system, in compliance with government and third-party payor regulations.

6. Interact with internal/external professional and facility operation leaders on a regular basis to provide information on initiatives, answer questions on outstanding account receivables items, and help ensure effective communication between the providers and team.

7. Leads employees to meet the organizations expectations for productivity, quality, and goal accomplishment.

8. Show proficiency in building and maintaining strong internal relationships while motivating and inspiring team members through effective consultative skills.

9. Serves as a knowledgeable resource in resolving insurance claim processing issues.

10. Monitors changes in the medical insurance industry and adjusts procedures accordingly.

11. Reviews and evaluates third-party claim policies and procedures for insurance plans and develops new procedures to improve the quality and quantity of work processed.

12. Develops, evaluates, implements, and revises policies and procedures related to reimbursement activities and improvement strategies.

13. Assist in troubleshooting problematic accounts, identify trends, and root causes, and lead internal and interdepartmental initiatives to resolve issues.

14. Participate in provider and third-party vendor conference calls regarding billing/reimbursement issues and trends, as well as Contract Interpretation and Joint Operating Committee meetings.


Skill Set Requirement:

Excellent written and verbal communication skills. (exceptional communication, interpersonal, listening, coaching, facilitation and conflict resolutions skills)

Strong computer skills including using Microsoft products like Excel, word, PowerPoint, outlook, one drive.

Computer, analytical, and organizational skills

Must have knowledge of medical practice operations.

Billing/collection practices and methodologies.

Comprehensive knowledge of claims management, HIPAA standards, CMS requirements, managed care, CPT, and HCPS coding)

Third-party payer procedures practices and contracts.

Governmental legal and regulatory provisions related to claims resolution activities.

Data analysis, systems design, problem identification, and medical data processing practice.

Skill in establishing and maintaining effective working relationships with other employees, patients, physicians, insurance organizations, and the public.

Requires a strong hands-on leader with the ability to prioritize, plan, and manage the Hospital, and Professional Claims Follow-up Department.

Analytical and statistical reporting skills

Minimum Requirements

Required Education/Course(s)/Training:

Bachelor's degree or equivalent education and/or 5+ years of experience in professional and hospital revenue cycle account receivable management

4+ years of professional and or hospital directly related management/leadership experience.


Preferred Education:

Master's degree and/or 10+ years related work experience.

Previous Vendor Management experience


Required Certification/Registration: None

Performance Expectations:

Successful achievement of the following:
Must be able to work independently and efficiently with little supervision.

Must have a strong desire to teach / transfer knowledge to team members.

Ability to recognize, evaluate, solve problems, and correct errors including complex claims processing issues.

Must demonstrate ability to work in fast-paced, deadline-oriented environment where the ability to meet deadlines is a must with constant communication required.

Demonstrates leadership and group cohesive skills that promote teamwork and group achievement.

Exhibit strong relationship management skills and the capability to navigate challenging interpersonal situations effectively.

Show proficiency in building and maintaining strong internal relationships while motivating and inspiring team members through effective consultative skills.

Ability to identify and implement process improvements to optimize revenue cycle performance.

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.