Your Role on the Team

Position Summary:
The Commercial/Managed Care Collections/Denials Manager reports to the Assistant Director-Patient Financial Services and is responsible for managing hospital accounts receivables (A/R) and the collections, denial, and workflow activities for Commercial/Managed Care payers - Commercial, Managed Care, Workers Compensation, TriWest/VA and all other third-party payers. The incumbent manages daily operations certifying timely accurate account evaluation, escalation, and resolution ensuring compliance with procedures, standards, and policies as well as regulatory requirements. This role is responsible for training, managing work performance, A/R analysis, resolution of operational and personnel issues, evaluations, hiring, and corrective actions as needed. Presents as a key liaison between PFS and various departments leaders within the organization to identify and resolve issues relating to charges, coding, appropriate modifiers, and claim adjudication to yield first pass clean billing and enhanced revenue recoveries. Also responsible for performing routine analysis of various key performance indicators, dashboards, and reports to optimize performance and maintain positive A/R disposition.
Reason, Comments, and Special Instructions: Updating the job description for the HB Patient Financial Services Patient Billing and Collection Supervisor 2 (JC 004669).

What It Takes to be Successful

Required Qualifications:

Thorough knowledge of medical and insurance terminology, and of billing and / or collections internal procedures and external regulations.

Strong time management and organization skills

Strong technical knowledge of CPT, HCPS and ICD-10 coding, LCD, NCD, MUE, CCI, Modifiers, authorization requirements and related documentation

Strong interpersonal and communication skills to collaborate and effectively manage conflict with all constituent groups

Strong analytical and report writing skills to effectively comprehend multiple reports and analyze array into actionable form

Strong ability to facilitate accurate and timely billing and collections

Solid, demonstrated leadership skills to coach, mentor, and strengthen the team's performance

Solid knowledge of human resources management policies, with the ability to evaluate and document human resources matters and performance.

Solid critical thinking and decision-making skills, with the ability to analyze and evaluate complex and/or difficult problems, determine appropriate level of intervention, and develop and apply viable solutions

Proficient in Microsoft Office and related programs (i.e. Microsoft, Excel, Outlook, PowerPoint, etc.)

Must possess the skill, knowledge and ability essential to the successful performance of assigned duties

Must have the ability to maintain a pace appropriate to the workload

Minimum of three (3) years of experience in billing and collections of Commercial, Managed Care, Medicare, Medicare Advantage, Medi-Cal, CalOptima, FQHC, and CCS and other programs that fall under the scope of Government programs and commercial billing

Minimum of five (5) years of related relevant experience in business office operations, consulting, or auditing

Excellent verbal and written English communication skills including the ability to convey complex information in a clear, concise manner

Demonstrated lead/supervisory skills to effectively oversee and prioritize staff activities and manage complex workflow and multiple priorities associated with billing and/or collections operations

Demonstrated ability to use sound judgment

Bachelor's Degree in related area and/or equivalent education/experience

Ability to function independently and as a member of a team

Preferred Qualifications:

Prior experience with and working knowledge of EPIC electronic health record

Total Rewards

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits.