Summary:
The Supervisor of PFS reports to the PFS Manager in charge of Denials Follow-Up Credit Balances and Contract Management.
Responsibilities:
Provides direction in day-to-day operations implements approved follow up procedures ensuring all Brown University Health claims activities are carried out in a timely and effective manner. Ensures all procedures are in compliance with applicable Federal and State regulations. Initiates requests for system updates as appropriate.
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Plans for and supervises effective utilization of resources (people financial material and equipment). Ensures appropriate staff coverage to meet anticipated needs as a result of planned and unplanned absences.
Provides/coordinates initial training of new staff in activities related to systems utilized by department and policies and procedures. Assists staff in prioritizing work activities. Identifies training needs through observation of staff work output audits and productivity reports and develops action plans. Works with Manager to document and update team policies and procedures.
Functions as key resource to staff in resolving complex issues that may need to be escalated because of complexity or payer issues. Assigns work ensuring equitable distribution by maintaining related productivity reports and monitoring work queues. Performs audits on staff to ensure accuracy level is maintained and provides results and feedback to individuals.
Maintains issues logs for individual payers as appropriate. Meets with internal/external representatives (e.g. third party payers and Brown University Health departments) to discuss and resolve claim and denial issues changes in process and the like. Monitors payer contracts within area of responsibility to identify communicate and resolve claims adjudication issues. Within level of authority extended by management authorizes adjustments in accordance with department policy. Ensures staff is apprised of changes in policy and procedures that relate to area of responsibility ensuring adherence to same.
Maintains up to date knowledge of changes in regulations that impact claims administration activities.
Regularly conducts individual and group meetings for department. Documents payroll for subordinate staff. Maintains vacation schedules and authorizes time off for staff. Adjusts coverage for vacation time and breaks as workflows fluctuate.
Organizes directs and controls follow up activities for Brown University Health for inpatient outpatient and practice claims for all payers. Assists in identifying opportunities and implementing change within department guidelines federal and state regulatory requirements resulting in the improvement of the accounts receivable cash flow and denial reduction.
Under direction of PFS Manager participates in special projects for workflow enhancements for entire department as needed.
Other projects duties assigned as needed.
Other information:
BASIC KNOWLEDGE:
High school graduate with knowledge of medical business office practices human resource management/training proficient in medical systems and additional training or experience in healthcare billing/coding.
Demonstrated knowledge of third party healthcare reimbursement regulations. Ability to think critically have strong analytical skills.
EXPERIENCE:
Three to five years of supervisory experience preferred. Experience with various payers and knowledge in the use of software applications databases and spreadsheets. Knowledge of third party payment issues and resolutions as well as effective communication organizational and leadership skills.
Desired: Epic PB experience.
WORK ENVIRONMENT ANDPHYSICAL REQUIREMENTS:
Work is performed in a typical office setting requiring extensive sitting. Position requires ability to speak see and hear within normal range.
INDEPENDENT ACTION:
Functions independently within Brown University Health*s policies and practices. Must be able to work independently in a manner to achieve goals objectives and productivity requirements. Refers unresolved complex issues to manager where clarification of department policies and procedures may be required.
SUPERVISORY RESPONSIBILITY:
Direct supervision for up to 25 full-time equivalent personnel.
Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.
Location: Brown University Health Corporate Services USA:RI:Providence
Work Type: Full Time
Shift: Shift 1
Union: Non-Union
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