Payer Escalations Supervisor

a month ago

  • Revenue Cycle Solutions
  • Remote
  • Full Time

Job Description:

The Supervisor of Payer Escalations manages payer related issues escalations (impacting RCM workflows or Insurance AR), partnering with client’s Payer Contracting team and coordinating with Insurance Provider Representatives. This individual will also track and monitor issues through to resolution. Presents statuses and major challenges in the escalation process via high level meetings with Integra and Client Senior/Executive leadership. Manages the variance review process to ensure that Integra is tackling all identified underpayments and working through expected means for resolution. Analyzes insurance AR for major increases that could result in potential escalations.

Responsibilities:

  • Serves as a point of contact for client’s Payer Contracting team regarding requests for relevant issues including reports or example packets
  • Partners with Insurance AR collections team to review, organize, submit issue escalations to provider reps. Tracks current numbers and statuses for payer related issues on issues logs. Reviews AR and addresses any major oddities that could be a result of payer issues/ incorrect claims denials or claims processing delays in order to have researched for potential resolution.
  • Hosts high level meetings on a biweekly basis with Client and Integra Senior and Executive leadership to present current Payer Issues and Variance Escalation tracking log and current statuses of each item. Identifies areas where additional support is required from leadership/Payer Contracting and addresses timely
  • Hosts high level meetings with Insurance Provider Representatives to address escalated issues and root causes in order to mitigate ongoing issues and then to work through projects with payer to result in bulk claims reprocessing when related to issue
  • Facilitate individual and team development; Mentor and counsel assigned personnel and meet with employees to discuss productivity results and quality of work product; Understand policy and administer corrective actions and/or a Performance Improvement Plans (PIP), when needed.
  • Supplies support with client Audit requests on an as needed basis (typically bi annually). Team will pull RCM related documentation for these audits. Timely turnaround is critical

Qualifications:

  • High School Diploma or GED required; Bachelor’s Degree in Business, Accounting, or Healthcare related field, preferred.
  • Two years of medical billing experience required
  • Three (3) years if previous mentoring and/or supervisory experience preferred.
  • Working knowledge of accounts receivables and management principles; ability to calculate figures and amounts such as discounts, interest and percentages.
  • Working Knowledge of payer processes
  • Proficient with the accounts receivable billing system and internet tools, (e.g., eligibility websites, address search engines); ability to perform basic reviews of accounts in the practice management system to determine status.
  • Competency in Microsoft Office tools including but not limited to word, excel, and outlook

Benefits:

Integra Connect, LLC provide a comprehensive benefits plan.

  • Medical/Dental/Vision Insurance beginning the 1st of the month following your date of hire
  • Paid Time Off
  • 401k with employer match
  • Paid Holidays and Floating Holiday

Equal Opportunity Employer

Apply Online

Format accepted Pdf, Doc and Docx