University of Rochester Senior Operations Supervisor in Rochester, New York
Full Time 40 hours Grade 052 Patient Financial Services
Provides supervisory and technical support to the Ambulatory Patient Accounts High Dollar team which includes all No Fault and Compensation billing and follow up and credit balance resolution. Oversees daily billing activities and maintains control over billing follow-up procedures for all High Dollar/No Fault and Compensation Ambulatory accounts. Ensures that all billing and payments are processed per payer regulations and contracts. Prepares and maintains daily, weekly and monthly quality indicators for staff. Serves as a liaison between department and ISD to ensure billing processes, programs and system generated reports are maintained. Assist the Ambulatory Manager with planning and problem solving, establishing goals and objectives for this area. Assist the Ambulatory Manager serving as a liaison between the department and other hospital departments in areas of customer service and satisfaction. Recognizes and supports the Strong commitment to service excellence.
Under general direction and with latitude for independent judgment:
Provide overall supervisory and technical support and direction for the Ambulatory High Dollar team (accounts with balances of $1.000. and more except Medicaid primary and study/grant/institutional accounts), for all No Fault and Compensation billing and follow up and for credit balance resolution; this team consists of Insurance Collection Specialists, Expeditor and Outpatient Account Coordinator. The No Fault/Compensation Expeditor completes collection activities on accounts with balances of no more than $999.00.; the No Fault/Compensation Coordinator completes billing activities on accounts for all dollar amounts.
- With support of the Ambulatory Manager, administer and coordinate hospital and departmental procedures relative to charges, billing, reimbursement and accounting functions
- Maintain detailed knowledge of all current third party coverage, federal and state billing, reimbursement and compliance regulations and procedures
- Distribute contract summaries to team members and departments including an outsourcing company
- Serve as a focal point for answering questions and solving problems for difficult and unusual accounts, assist in problem identification and resolution
Prepare ambulatory team operational reports and special reports as needed to identify key indicators for A/R activities using specific criteria measuring quality, quantity and timeliness of tasks performed. Prepares and reviews with staff the daily, weekly and monthly quality indicators of A/R activity in each payer area. Initiates corrective action or recommends solutions as appropriate. Prepares specific reports developed with payers in identifying accounts requiring provider intervention.
- Compile and review monthly A/R figures and notes with Ambulatory Manager
- Create and run A/R templates to review problem areas (e. g. Cancer Center, Medicare denials, Botox, etc.)
- Create and run reports for specific lines of business for staff to use to complete follow up (e.g. WNY)
- Create and run reports to review potential problem services when codes are wrong (e.g. CPT, revenue code)
- Participate in projects to get accounts correctly paid; meeting with provider representatives, having conference calls with provider representatives, creating spreadsheets with visits either under or over paid
- Ensure that the accounts on the PSR and ARC logs are resolved timely and accurately
With support of the Ambulatory Manager, develop audit procedures within the Ambulatory billing area to ensure payments from all third–party payers are based on rates identified on negotiated contracts.
- Ensure timely processing of credit balances when overpayments occur using the CBAS Retraction system
- Compile and review A/R reports generated within the billing systems to ensure accuracy and reconciliation
- Coordinate and provide support for all internal and external billing audits, reviews or projects
- Coordinate resolution of accounts that change patient types prior to patient’s being discharged (In’s to Out’s) with Utilization Management.
- Ensure that No Fault and Compensation billing and collection processes are completed timely
- Sign off on all insurance and self pay refunds created by the High Dollar team
- Attends arbitration and other legal proceedings to resolve outstanding accounts
With Ambulatory Manager, develop goals, objectives and operating policies and procedures for the Ambulatory High Dollar and NoFault/Compensation team. Develop cross-training programs within the area.
- Identify tasks to reduce >90 day bucket in A/R and to follow up on 2nd level claims
- Ensure that timely filing guidelines are followed
- Ensure time schedules are adhere to for completing tasks
Ensure a positive working environment through suggestions on team building to promote heightened team morale.
- Provide training, coaching and reinforce billing and customer service skills to team members to ensure exceptional service
- Empower team members by providing the appropriate level of decision making
- Recognize and reward team members for their contribution to the department
- Seek feedback from other departments to improve processes and level of service within the department
- Communicate with departments re: problem visits.(e.g. Cancer Center, PSR’s)
Complete supervisory activities:
- Complete performance evaluations for designated staff
- Interview and make recommendations for new hires
- Handle time reporting requirements in accordance with state and federal regulations
- Address personnel disciplinary issues
- Ensure that staff complete the annual In Service requirements
Act as authority in the absence of the Ambulatory Manager, exercising tact and good judgment.
- Attend meetings and seminars in the absence of the Ambulatory Manager when appropriate.
- Attend the Rochester Area Patient Accounts Managers meeting
Other duties as assigned
- Attend continuing education seminars as needed including Medicaid and Medicare.
- Represent the department on various internal and external committees
- Participate in department/team staff meetings, educational classes and training
- Attend monthly department and team staff meetings
- Stay current on HIPAA guidelines through education and reading monthly emails.
- Participate in educational training such as Strong Commitment ICare and annualIn Service
- Join PAO committees such as planning PAO events or addressing employee issues
- Cross Train on team processes to enable assistance and fill in as needed
Bachelors or Associated Degree in Business, Health Care Administration or related discipline and 3 years of relevant health care experience or an equivalent combination
EOE Minorities/Females/Protected Veterans/Disabled
Job Title: Senior Operations Supervisor
Location: Strong Memorial Hospital
Job ID: 202621
Full/Part Time: Full-Time