Responsibilities

• Oversee the planning, organization, direction, and implementation of all claims management processes and controls to ensure the accuracy and timeliness of claim submissions, collections efforts, and payment distribution in compliance with contractual, state, and federal regulations
• Stay updated on insurance industry regulations, policies, and coding standards, ensuring compliance and implementing necessary changes
• Ensures efficient accounts receivable management. Use routine monitoring reports, such as claim submission rates, denial rates, and reimbursement trends, to oversee the revenue cycle operational functions.
• Identify and address areas of improvement to maximize reimbursement and minimize billing errors. Collaborate with insurance companies, B2B clients, and third-party payers to address claims inquiries, appeals, and payment discrepancies.
• Monitors work queues responsible for and develops remediation plans for any backlogs that could occur operationally
• Supervise patient billing and collections staff on a daily basis, including hiring, monitoring productivity standards, and departmental training
• Formulate appropriate professional targets for each of the team members. Ensure collection goals for the department are met.
• Attend, participate, and lead at required meetings and work groups.
• Foster positive working relationships with internal and external stakeholders, promoting effective communication and collaboration
• Provide leadership. Serve as a role model and share resources.
• Actively participate in department projects and improvement initiatives
• Interface with upper management, including Director, VP, and Sr. VP in Operations,