• Manages the department within the established budget.
• Manages the precertification process between the physician practice and the hospital/ASC and tracks statistical information monthly.
• Manages the coding process implemented to assure the most accurate and cost effective coding of all claims.
• Manages the filing and resolution of claims with individual carriers or agencies. Insures maximum reimbursement through strategic financial planning.
• Monitors changes in the medical insurance industry and adjusts procedures accordingly. Aggressively pursues cost reimbursement through settlement negotiations.
• Reviews and evaluates health insurance claim policies and procedures for insurance plans, develops new procedures to improve the quality and quantity of work processed.
• Monitors and evaluates monthly insurance reimbursements compliance and budgets.
• Manages updating of contract matrix with accurate terms and fee schedules and establishes a common reimbursement grid by procedure code.
• Manages the collection of accounts, the maintenance of the Medicare bad debt and the outsourcing of account receivables following appropriate protocols.
• Solves difficult insurance claim problems.
• Supervises, trains, and mentors assigned personnel. Evaluates performance and recommends merit increases, promotions and disciplinary actions.
• Initiates and answers pertinent correspondence. Prepares and writes reports. Maintains required records and files.
• Maintains knowledge of and complies with established policies and procedures.

Education:

• Bachelor’s degree in business or equivalent. Master’s degree preferred.

Experience:

• Minimum five years supervisory experience in a health care setting.