Job Title: Manager Billing and Insurance Follow-Up
Job Status: Full-time, Exempt
Department: Insurance A/R
Immediate Supervisor Title: Director Insurance A/R and Cash Applications
Job Supervisory Responsibilities: Supervisor Denials (Non-Medicaid MCO), Supervisor Denials (Medicaid MCO), Supervisor Special Billing and Follow-Up
Accountable for overall management of Billing and Insurance Follow-up for KMSF. The Billing and Insurance Follow-Up Manager provides leadership and oversight for the KMSF Billing and Insurance Follow-Up team. Responsibilities include planning, developing, implementing, and operating a structure of centralized/consolidated activities for Billing and Insurance Follow-Up including the functions of Physician Practice Billing, Insurance Follow-up and Denial Management. Manages assigned areas of responsibility to provide safe, effective, and appropriate care in a fiscally responsible manner through direction, support and development of staff, and collaboration with other department leaders.
This position works to appropriately integrate operations, facilitate best practices, achieve efficiencies, and align with KMSF’s and UKHC’s strategic plan while maintaining quality standards and ensuring the department is operating within rules and regulations of KMSF, State and Federal laws and regulations.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Essential Functions & Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Manages the Billing and Insurance Follow-Up team and collaborates with department leadership across KMSF to ensure timely, accurate billing, follow-up and collections, including denial management.
Directs the management of workflow across Billing and Insurance Follow-Up departmental functions
Establishes performance standards (qualitative and quantitative) for Billing and Insurance Follow-Up. Monitors performance and directs improvement efforts when performance gaps are identified.
Serves as an internal consultant on Billing and Insurance Follow-Up issues including payer-specific billing requirements and denial reduction activities.
Administers the development, implementation and adherence of policies and procedures for each departmental function.
Develops long and short term departmental goals and objectives to support departmental, revenue cycle and hospital strategic plan. Directs staff in accomplishing same per schedule.
Designs, performs, and appropriately utilizes the findings of performance improvement activities Billing and Insurance Follow-Up Services, and follows up on both positive and negative quality improvement findings. Utilizes results of performance monitoring as an integral part of employee performance appraisals; monitors, evaluates, appraises or disciplines employee activities per organizational standards.
Conducts regularly scheduled supervisor meetings to communicate issues with overall work unit effectiveness and issues identified across the KMSF Revenue Cycle and clinical departments.
Works closely with leadership and employees to improve work relationships, build morale, increase productivity, and retention.
Coordinates and works collaboratively with key stakeholders and various department administrators, physicians, IT, etc. to ensure needs of the organization and patient are being met.
Participates on KMSF and UKHC committees and task force committees as needed.
Establishes a strategic relationship with third party vendors and payors. Assessment of new and existing vendor partnerships on an as needed basis.
Develops an annual budget and monitors variances for department in collaboration with Director of Insurance A/R and Cash Applications.
Directs recruitment and retention of qualified team members in collaboration with HR.
Manages the development and implementation of training and education programs in collaboration with the Training Department to address needs of the functional areas of responsibility and as mandated by regulatory, accrediting, licensing and department standard operating procedures.
Manages the Billing and Insurance Follow-Up team in compliance with established organizational and department policies and procedures, regulatory requirements and accreditation standards.
Stays abreast of new developments in areas of responsibility and proposes new policies and revisions to existing policies and procedures or use of technology when appropriate and cost effective.
In collaboration with Supervisors, ensures time is recorded accurately and timely in accordance with KMSF HR policies and procedures. Approves and monitors department time off. Oversees the development of coverage plans and ensures staff cross-training is in place.
Understands and adheres to organizational compliance, safety and patient privacy standards as they appear in the organizational policies.
Performs other related duties as assigned.
Success in managing responsible functions will be measured by the following metrics:
Accounts Receivable Days
Overall Denial Rate
Avoidable Write-offs – Timely Filing
Labor Target Variance
Accounts Receivable Days >90
Adherence to compliance regulations and training standards
Departmental quality performance standards
Clean claim rate
Education/Training: Bachelor’s degree or equivalent combination of education and experience in a health care field required.
Experience: Five or more years of healthcare experience required with recent managerial experience in physician billing and/or follow-up; experience in a large academic group preferred. Working knowledge of government health policies and reimbursement methodologies required.
Functional and Technical Competencies - to successfully accomplish the above, the following is required;
Professional and facility billing
Coding (ICD10, CPT and HCPCs codes and modifiers)
Organizational and management practices as applied to the analysis and evaluation of programs, policies, and operational needs
Applicable federal, state, and local laws, codes, and regulations
Assist in the development of goals, objectives, policies, and procedures for the department.
Plan and conduct effective management, administrative, and operational studies.
Plan, organize, and carry out assignments from management staff with minimal direction.
Conduct research on revenue cycle metrics not meeting goal.
Interpret, apply, explain, and ensure compliance with applicable federal, state, and local laws, codes, and regulations.
Prepare clear and concise reports, correspondence, policies, procedures, and other written materials.
Maintain confidentiality of sensitive personal information of applicants, employees, former employees, and other matters affecting employee relations.
Analyze situations and identify pertinent problems/issues; collect relevant information; evaluate realistic options; and recommend/implement appropriate course of action.
Organize and prioritize a variety of projects and multiple tasks in an effective and timely manner, organize own work, set priorities, and meet critical time deadlines. Possess good communication, verbal, and interpersonal skills to interact effectively with people of different educational levels. Exhibits ability to communicate effectively through oral presentation and written documentation.
Display constructive problem solving and emotional maturity.
Modern office practices, methods, and computer equipment
Computer applications related to the work
English usage, grammar, spelling, vocabulary, and punctuation
HIPAA rules and regulations
Quality/Compliance: Achieves a standard of excellence with work processes and outcomes, honoring Organizational policies and all regulatory requirements.
Customer focus: Strives for high customer satisfaction, going out of our way to be helpful and pleasant, making it as easy as possible on the patient, family member or customer rather than our department or organization.
Safety Mindset: Promptly reports or corrects any unsafe condition. Records/reports the need for service maintenance or repair of equipment and removes any faulty equipment from service.
Communication: Balances listening and talking, speaking and writing clearly and accurately, influencing others, keeping others informed.
Collegiality: Is helpful, respectful, approachable and team oriented, building strong working relationships and a positive work environment.
Initiative: Takes ownership of the work, doing what is needed without being asked, following through
Efficiency: Plans ahead, manages time well, is on time, is cost conscious, and thinks of better ways to do things.
Coach-ability: Is receptive to feedback, demonstrates a willingness to learn, and embraces continuous improvement.
Demonstrates an ability to work in a collaborative manner.
Diversity: Acknowledges and respects cultural diversity in all interactions.
Internal Number: 00020719
About Kentucky Medical Services Foundation
Kentucky Medical Services Foundation, Inc. (KMSF) is a 501(c)(3) tax-exempt corporation located solely in Lexington, Kentucky, which serves in a support organization role for certain functions of the University of Kentucky. KMSF was organized as a nonstock, nonprofit Kentucky corporation in 1978. KMSF manages certain provider billing, accounts receivable, accounts payable and compliance functions, as well as providing other financial and fiduciary functions for the College of Medicine clinical departments and other components of UK HealthCare.