Supervises the day-to-day activities involved in the management of the accounts receivable for the organization's all payors and accounts. Monitors Epic Claim Edit, Follow Up, Account and Credit Work Queues for trends and issues. Manages external vendor relationships related to claim submission and reimbursement issues. Ensures compliance with all contractual, state and federal requirements. Supervises PA Government, Commercial, NCMC, and WC Unit's Team Lead and Patient Account Representatives
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Supervises the PA Government, Commercial, NCMC, and WC Unit ensuring compliance with health plan standards and contractual requirements. Responsible for maintaining established DuPage Medical Group Coding and Reimbursement guidelines. Support Customer Service Department as needed
Ensures staff compliance to Medicare and IDPA regulations through audit process.
Monitors health plan claim payment and/or denial trends and identifies potential problems through established insurance follow-up activities. Maintain established MGMA AR aging standards. Researches complex problems and issues and works with health plan provider representatives and/or other DMG departments to resolve them. Establishes workarounds, makes recommendations and works with manager on process improvements.
Responsible for setting goals and monitoring staff productivity. Works with staff to meet goals and provides feedback. Provides monthly reporting to manager.
Demonstrates knowledge of coverage and registration guidelines for all government and capitated coverage's.
Understands and applies all carrier requirements for referrals and precertification. Works with DMG Utilization Management on complex retro authorization requests.
Coordinates training for all newly hired PA staff to ensure all PA policies and procedures are understood and consistently applied. Develops unit's training program.
Develops and maintains good relations with PA staff, physician office staff, payor and vendor representatives.
Maintains confidentiality of all information as stipulated in the HIPPA Privacy Rules and DMG confidentiality policy.
Responsible for development of Team Lead and Patient Account Representatives. Prepares annual performance evaluations, developmental opportunities and sets future goals.
Maintains attendance records for staff, tracks occurrences and develops corrective action plans in support of DMG established policies and procedures. Approves PTO requests.
Performs other projects and duties as related to department objectives. Participates in other committees as assigned.
KNOWLEDGE SKILLS AND ABILITIES:
Effective in communicating verbally with other staff and departments related to electronic claim files and patient statements.
Schedules and prioritizes for self. Establishes strategies to accomplish specific results and produces desired results.
Demonstrates the ability to guide and develop staff through positive reinforcement and teamwork.
Effective in identifying and analyzing problems. Generates alternatives and identifies possible solutions.
Fosters teamwork and positive rapport within all departments to maximize achievement of goals.
EDUCATION and / or CERTIFICATION/LICENSURE:
ABOUT BONCURA HEALTH SOLUTIONS
Join one of the fastest-growing healthcare teams in Chicagoland and experience what superior care and innovation is all about. Boncura Health Solutions is a division of DuPage Medical Group, the largest independent, multi-specialty physician group in the state that provides physician-directed healthcare focused on quality, efficiency and access. Many Boncura employees support the DuPage Medical Group team, providing administrative services to hundreds of physician providers and partners, and helping them stay ahead in the ever-changing healthcare world. From claims processing and billing, to call center management and credentialing, Boncura is helping to change the landscape of healthcare for the better. Become a part of our care team. We have great benefits and great opportunities for growth.
Dupage Medical Group