Clinical Revenue Supervisor

The Analyst of DCAM AR will support the Manager of DCAM for the oversight physician claims billed through our hospital outpatient clinics. These role will have oversight of the effective operations of claim submission, no response, denial follow-up, appeals, and payer relations/escalation. This role will have a combination of internal and external staff reporting to them. They will supervise the daily activities of this operations team. Sets priorities for the team to ensure tasks are completes and coordinates work activities with other supervisors. Through this work they will solve complex problems related to revenue cycle operations as well as ensure successful billing, collection, and compliance activities within the department.ResponsibilitiesOversees the AR follow-up and denial resolution process with minimal direct oversight.Proactively reviews current workflows for AR resolution with the intention to improve, implement, communicate and maintain an efficient AR resolution process. Identifies and resolves the systematic and/or operational root causes of denials and outstanding AR.Oversees and manages the AR follow-up work queues (WQ) and proposes both short and long-term enhancements that support business needs.Assists manager with maintaining payer scorecards, creating payer meeting agendas, and communicating issues to provider representatives.Works with the payers on escalated account resolution, identifies and submits high-complexity and other escalated payer projects.Creates simple to moderately-complex reports that are necessary for payor projects using a variety of business tools.Proactively reviews payer communication, initiates payer policy and rule change implementation, and proposes changes to front-end or back-end edits.Communicates clearly and professionally with the other UCPG units, clinical departments, external vendors, and payers in effort to build partnerships that result in denial resolution and prevention.Provides AR follow-up expertise to other UCPG and UCM business units as needed.Works closely with the Coding Education team to suggest opportunities for coder and provider training. Assists clinical departments in resolving escalated AR and denial issues.Works with Hospital Billing (HB) team on AR issues that cross between PB, HB, or SBO applications.Provides AR follow-up training to existing and new AR follow-up staff.Completes quality audits for denial and AR resolution activities.Creates denial Appeal, Reconsideration, and Letter of Medical Necessity Letter templates and trains staff in effectively using these templates.Creates workflows and assists manager in developing and documenting policies and procedures. Provides support to UCPG and external entities for any AR issues. Provides root cause analysis of AR issues and denials and implements tools and solutions to reduce denials and other manual AR follow-up work.Provides direct support to AR resolution in effort to better identify trends and new issues.Assists the manager in monitoring and trending AR and denials, provides root-cause analysis, assists in root cause resolution and identifies opportunities to improve workflows.Supervises the day-to-day activities of the Clinical Revenue support staff.Prepares departmental compliance efforts by participating in training sessions, performing audits, and promoting an understanding of procedures, policies, and expectations.Has a moderate/solid understanding of coding procedures, workflow issues, billing infrastructure, and performance of Clinical Revenue staff. Informs department administrators, physicians, and Coder/Abstractors of regulatory changes.Participates and may lead in training sessions, performing audits, and promoting an understanding of procedures, policies, and expectations in promotion of compliance efforts.Performs other related work as needed.Minimum Qualifications Education:Minimum requirements include a college or university degree in related field.Work Experience:Minimum requirements include knowledge and skills developed through 2-5 years of work experience in a related job discipline.Preferred QualificationsExperience:Experience with physician revenue cycle specific AR follow-up and denial resolution. Experience with diagnosis and CPT coding terminology. Experience with charge correction activities.Experience using physician billing/revenue cycle software and electronic medical records system.Proven ability to effectively develop and introduce procedures and processes to others both within Department and with Manager/individuals in other UCM departments.Previous EPIC experience.PC experience and MS Office (Word, Excel, PowerPoint).Preferred CompetenciesConfidentiality/discretion must be maintained at all times.Ability to handle multiple concurrent tasks in a competent and professional manner in a fast paced atmosphere.Ability to understand medical terminology/documentation.Ability to solve problems independently with limited direction from the supervisor.Ability to work for long periods of time in a sitting position, or at a keyboard.Ability to bend/kneel to access files in filing cabinets or storage boxes. Ability to drive or commute to various sites for meetings.Ability to work flexible hours.Demonstrated knowledge of third-party payer systems and related rules and regulations.Demonstrated analytics and report knowledge. Comprehensive working knowledge word processing, database, and spreadsheet software. Demonstrated knowledge of billing systems.Ability to use electronic billing system.Exceptional organization skills.Excellent written and oral communication skills.