Supervisor - Billing (Healthcare)

Summary

Assists Director of Billing and Contracts with all aspects of mental health service billing for AHCCCS, Medicare and Commercial plans. Responsible for training Billing Processors in verification of mental health insurance benefits, denial resolution, and payment application from provider EOBs and collections. Maintains training manuals to comply with various payer requirements and department’s policies and procedures.

Essential Duties and Responsibilities

• Supervises daily operations of the billing team
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• Ensures effective benefit verification and Prior Authorization processes
• Assists billing team members in resolving Prior Authorizations discrepancies and member eligibility verification
• Resolves and assists billing team members with pended billing errors for Medicare, Commercial and Medicaid payer claims
• Evaluates EOB denials, assists the team in resolution of denied claims and resubmit process.
• Prepares and reports payor payments, trends regarding denials, and trends regarding rejections.

Routinely monitors and ensures eligibility segments are documented correctly.

• Routinely prepares, maintains and reports status of Payment Reconciliation Report and Unapplied Report
• Works directly with Data Validation team to review and resolve audit findings.
• Assists in review and updating of various billing processes and procedures.
• Meets regularly with direct reports to review goals and objectives, and to provide support to ensure accurate and timely billings.
• Continually assesses daily billing process, assists in implements changes and monitors results.
• Maintains and updates appropriate training documentation in accordance with agency and Billing department requirements.
• Resolves grievances and other personnel problems within position responsibilities. Provides input based on observations related to counseling and disciplinary issues. Implements corrective actions/performance improvement plans as required.
• Assist in developing policies and programs within the department.
• Acts as a positive role model for staff.
• Coordinates the assignment of tasks and helps resolve technical and operational problems. Evaluates the impact of solutions to ensure goals are achieved.
• Creates an environment that nurtures empowerment of staff members; encourages the development of self-directed work teams; proactively pursue and encourage continuous quality management and innovation.
• Provides effective coaching and administrative supervision of assigned staff.
• Ensures adequate equipment and supplies for assigned area.
• Ensures compliance to all health and safety regulations and requirements.
• Performs other duties as assigned in keeping with the growth and general responsibilities of the position.

SKILLS / REQUIREMENTS

Education:

• Associates degree in related field.  Additional experience may substitute for a degree.

Experience:

• 4-6 years billing & claims processing experience and
• A minimum of 2 years supervising others

Certifications:

• Certified Professional Coder, preferred

Additional Requirements:

• Valid Arizona Driver’s license, proof of current insurance and willingness to use personal vehicle. Driver’s license is an essential requirement for performing duties for this position.
• Clean Motor Vehicle Record - no more than 2 moving violations or a license suspension in past 3 years.

Skills:

• Bilingual skills a plus.
• Proficient verbal and written communications
• Proficient knowledge of healthcare claims best practices standards
• Understanding of AHCCCS, the Arizona healthcare delivery systems
• Working knowledge of Medicare claims processing
• Intermediate level of overall computer proficiency