Supervisor Director, Payment Compliance
Duties (included but not limited to):
Analyzes hospital claims to identify contractual underpayments or billing errors.
Resolves underpaid claims from various payer products including HMO, PPO, Medicaid, Medicare and Workers' Compensation.
Articulates contract provisions to representatives from healthcare payer companies and government agencies.
Contacts payer companies via phone or correspondence and initiates request for payment.
Performs appropriate follow up with Payer and gains commitment for payment.
Escalates Payer lack of response and/or lack of payment within Payer organization as appropriate.
Identifies and communicates contract interpretation issues and language discrepancies to leadership as appropriate.
Identifies Payer company trends and communicates trends to supervisor for further action/escalation.
Serves as a subject matter expert in Payer contract dispute resolution process.
Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement"
Other duties as assigned
KNOWLEDGE, SKILLS & ABILITIES
Communication - communicates clearly and concisely, verbally and in writing.
Persistence comfortable pursuing, rebutting and escalating issues as appropriate.
Goal-oriented holds him/herself accountable to achieving shared and personal goals.
Customer orientation - establishes and maintains long-term customer relationships, building trust and
respect by consistently meeting and exceeding expectations.
Interpersonal skills - able to work effectively with other employees, patients and external parties.
PC skills - demonstrates high proficiency in Microsoft Office applications and others as required.
Policies & Procedures - demonstrates knowledge and understanding of organizational policies,
procedures and systems.
Mathematical skills - able to perform advanced mathematical calculations and balance and reconcile figures
Writing skills advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately.
Bachelor's degree required.
Master's degree preferred.
Work from Home Requirements
Designated Work Area: Remote Workers are required to maintain a separate, designated work area at home
Minimum Technical Specifications Home Internet Connectivity: Download and Upload