Manage the daily operations of the Hospital AR collection team consisting of 12 representatives within CVBO. Focus on Medicare, Medicaid and other State and Federal Government payors over 3 different states. Work with various revenue cycle areas, including the Coding and Clinical departments in resolving claim denials and appeals. Work with senior leadership to improve processes, increase accuracy and resolve billing issues to achieve department goals. Review of various reports from higher dollar accounts down to credit balances for accuracy and timely resolution. Review of productivity and quality reports to monitor inventory and accurate review of accounts.

Assist in supervising and monitoring the daily operations of the AR Follow-up team through reports. Provide subject matter expertise of payors for account receivable billing, follow-up, and denials. Work with management to identify and resolve problems with processes. Provide training and assistance with processes and procedures. Assist in resolution of credit balances and takebacks. Auditing of team accounts to ensure proper documentation to support timely and accurate resolution of accounts.

Work account receivables and credit balance reports for Commercial insurances, HMO’s and Medicare. Interact by phone and mail with third-party payers, and patients concerning follow-up for denied or suspended claims. Submit claim adjustments and appeals as needed. Update systems accordingly for proper claim submission. Maintained company productivity and quality expectations monthly.

Corporate liaison positioned at hospital to help support Corporate Central Billing Office. Work claims through clearinghouse to correct edits for medical necessity, missing or invalid CPT/HCPCS codes, modifiers, and any additional coding issues. Set up SNF Consolidated Billing claims with neighboring nursing facility for appropriate monthly billing. Interact by phone and mail with third party payers, provider representatives and patients concerning follow-up for denied or suspended claims. Downloading of electronic files into system for cash posting. Work various operating systems to minimize outstanding revenue.

Responsible for the efficient operation of the billing team, including compiling itemized hospital bills, verifying patient insurance coverage and computing insurance benefits. Work closely with the Admitting office, Medical Records and Physician office staff. Assist the manager of patient accounts in the planning, developing and expediting of third-party reimbursement for assigned insurances. Submit and monitor claim submissions worked by team members. Review claims that are rejected or denied from payers and take appropriate actions in a timely manner. Orient and train new members on office and billing procedures and processes in conjunction with departmental policies. Assist manager in review and development of team members. Attend any and all seminars conducted by the hospital to continually improve current supervisory skills.

Work claims through clearinghouse to correct edits for medical necessity, missing or invalid CPT/HCPCS codes, modifiers, and any additional coding issues for Medicare, and Tricare. Work the Medicare quarterly credit balance report to clear outstanding credit balances. Set up SNF Consolidated Billing claims with neighboring nursing facility for appropriate monthly billing. Interact by phone and mail with third party payers, provider representatives and patients concerning follow-up for denied or suspended claims. Main focus on federal and state insurances including MassHealth, Veteran Administration, and Medicaid MCO plans. Attend off campus billing seminars to stay informed on current regulations

Work account receivables and credit balance reports for Commercial insurances, HMO’s and Medicare. Interact by phone and mail with third-party payers, provider representatives and patients concerning follow-up for denied or suspended claims. Submit and process claims electronically thru a clearinghouse. Process and sort incoming insurance correspondence and document patient account. Some work with Auto and Workers Compensation claims

Post third party insurance payments and adjustments to patient accounts. Sort and prepare incoming payments for posting.

Issue return credit to customer accounts and adjust inventory. Data entry of labor hours and cases shipped for daily productivity reports. Shipping and receiving experience.