RCM Medical Billing Operations Supervisor

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Stellenbeschreibung:

Responsibilities

The RCM Medical Billing Operations Supervisor position works under the supervision of the RCM Manager.
Oversees the front end of the medical billing cycle, namely timely and accurate claim submission processes.
Supervises the Coding and Claim Review Specialists and Medical Billing Assistant.
Ensures acceptable resolution of failed claims in the EHR to promote timely submission of claims.
Monitors unbilled claims and upfront rejections.
Responsible for coding and mapping in the EHR, maintaining payer information, billing configurations, fee matrices, and rules for the claim engine.
Performs RCM Billing Audits and may assist in running regular reports to track department goals and progress.
Provides direct supervision to the Coding and Claim Review Specialists and Medical Billing Assistant, meeting regularly to provide guidance, direction, support, and resources necessary for efficient job performance.
Conducts quarterly and annual performance evaluations and assists staff in establishing and achieving individual goals aligned with departmental objectives.
Troubleshoots, investigates, and resolves failed claims within the claim management system daily to ensure timely claim submission and reimbursement.
Configures, maintains, and monitors payer billing settings, procedure code, bill-next, and adjustment reason code mappings within billing systems.
Applies proactive problem-solving, analytical thinking, and attention to detail to identify, research, and resolve billing, coding, and claim processing issues.

Requirements

Associate or bachelor’s degree in medical Billing and Coding, Health Information Management, Healthcare Administration, or a related field preferred.
Minimum of five (5) years of experience in medical billing and coding, preferably within a nonprofit healthcare or behavioral health setting.
Demonstrated experience working with claims clearinghouses, including identifying, researching, and resolving claim rejections and edits.
Working knowledge of electronic claim transactions, including 837 EDI files and related healthcare billing standards.
Comprehensive understanding of commercial insurance, Medicare, Medicaid, and managed care billing requirements, including Washington State Provider One Eligibility.
Strong knowledge of ICD-10-CM, CPT, HCPCS, HCFA 1500, and UB-04 claim forms, as well as payer-specific reimbursement requirements and regulations.
Proficient in Microsoft Excel, including the use of sorting, filtering, formulas, conditional formatting, pivot tables, and data analysis functions.
Strong analytical and critical-thinking skills with the ability to identify trends, troubleshoot complex billing issues, and develop effective solutions.
Excellent verbal and written communication skills with the ability to communicate clearly and professionally with staff, leadership, payers, and external stakeholders.
Reliable attendance and dependability, with a demonstrated commitment to meeting job responsibilities and organizational expectations.

Core Competencies

Demonstrates expertise in medical billing and coding processes, including claim submission, coding compliance, and payer regulations. Proficient in managing billing operations, conducting audits, and resolving complex claim issues to ensure timely reimbursement.