Mgr RC Billing & Claim Edits
Wellstar Health Systems

Facility: WAB - Wellstar Administrative Building
Job Summary:

The Manger Billing and Claim Edits provides direct supervision and daily management of the Claim Edits and Billing team through training, coaching, and use of qualitative and quantitative reports to measure performance. The Manager Billing and Claim Edits is accountable for the timely resolution of claim edits, submitting claims within third party insurance payer specified timeframes, and managing the unbilled inventory.

Core Responsibilities and Essential Functions:

Primary Responsibilities
* a.Ensures staff follow-up on claim edits promptly and is held accountable for aged unbilled receivables.
* b.Conducts regularly scheduled staff meetings to discuss new or modified procedures within department.
* c.Reviews and approves staffs time and attendance records.
* d.Plans work schedules and assigns work to staff to ensure adequate service and coverage.
* e.Ensures WellStar policies and procedures are current and updates them as necessary.
* f.Approves administrative write-offs in accordance with the WellStars Adjustment Approval Policy, and audits staff level write-offs to ensure appropriateness.
* g.Addresses/resolves issues relating to patient accounts.
* h.Assumes responsibility for resolving inter/intradepartmental issues quickly and effectively.
* i.Sets productivity and quality standards and holds staff accountable. Responsible for direct report staff education and provides staff training and education.
* j.Appropriately administers praise or disciplinary action, completes performance evaluations on time, resolves conflict positively/constructively, creates a positive work environment, and encourages/respects/values the contributions of all individuals.

Secondary Responsibilities
* a. Review, analyze, and interpret monthly management reports to make informed managerial decisions to increase productivity or resolve issues. In addition, must communicate recommendations or findings to Revenue Cycle Leadership
* b.Monitor healthcare market changes as it pertains to both local and national payer trends, payment rules, and payer contracting trends
* c.Establish and maintain working relationships with other revenue cycle departments
* d.Maintain professional conduct and good working relationships with co-workers, supervisors, and staff
* e.Maintain a system to informally and formally recognize staff for accomplishments
* f.Demonstrate a thorough understanding of all state and federal regulatory requirements for government and third-party agencies to ensure compliance and appropriate reimbursement.
* g. Maintain standards in the use of claims management and denial management software, and all other software applications that are used in Hospital Billing and Follow Up for consistency in account management
* h.Develop and maintain positive working relationships with third party payers to facilitate the resolution of issues and expedition of payments
* i. Oversee and ensure the completion of all employee paperwork and files, including the accurate and timely completion of timecards, employee evaluations, leaves of absence, workers compensation reporting forms, and employee education files
* j. Communicate and participate in regular meetings with contracted and non-contracted payers to identify, present, monitor, and resolve operational issues related to new medical policy, products, disputed payments, and/or system-related issues
* k. Identify and bring to management attention any opportunities for system or process improvements
* l. Assist in the development of criteria-based performance evaluations and staff job descriptions
* m. Approve and oversee the tracking of all employees sick and/or vacation requests in accordance with department policy and staffing requirements

Performs other duties as assigned

Complies with all WellStar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

BA or BS, preferably in Business, Accounting, Finance Required

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 10 years commiserate work experience. Required

Required Minimum Skills:

Broad proven practical experience in hospital billing, follow up, and customer service
Knowledge of hospital billing process and revenue cycle environment
Knowledge of hospital based billing is preferred
Knowledge of state and federal regulations as they pertain to collection processes and procedures
Knowledge of and skill in the use of computers and related systems and software
Knowledge of insurance plan payment practices and billing requirements
Knowledge of and detailed understanding of managed care agreements
Skill in problem solving in a variety of settings
Skill in motivating and directing the work and activities of staff with the ability to effectively delegate
Skill in technical and professional accounting
Skill in good oral, writen, and interpersonal communication, grammar, and spelling
Skill in time management and project management
Ability to effectively conduct regular department meetings
Ability to work cooperatively in a team environment
Ability to set climate for performance at optimum levels
Ability to establish and maintain a cohesive work team
Ability to work efficiently under pressure
Ability to apply appropriate supervisory, management, and leadership techniques in an operational setting
Ability to work independently and take initiative
Demonstrates a commitment to continuous learning and to operationalize that learning and top operationalize that learning
Ability to willingly accept responsibility and/or delegate responsibility
Ability to deal effectively with constant changes and be a change agent
Ability to deal with difficult people and/or difficult situations effectively
Ability to set priorities and use good judgement for self and staff

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