The Patient Financial Services Supervisor is responsible for overseeing Global Transplant institutional payer claim submissions in accordance with applicable payer regulations and guidelines. The PFS Supervisor acts as a subject matter expert for billing functions and can troubleshoot and resolve issues that have a potential impact on revenues.
Receive, analyze, and answer inquiries from Inova staff, payers, and vendors at a supervisory level regarding the review and resolution of claim edits and payer rejections. Adhere to government regulations and commercial payer billing guidelines for compliant billing.
Determine appropriate staffing coverage and redistribute workloads for timely billing of commercial insurance claims.
Monitor individual team members' productivity, performance, and compliance to policies, procedures and guidelines. Provide timely coaching and feedback to further develop staff knowledge and improve performance through one-on-one sessions and/or scheduling and leading recurring team meetings.
Identify billing trends and collaboratively work with other departments to design and implement training programs and training materials to disseminate information and validate consistent billing practices.
Identify, research, and resolve unusual, complex or ongoing claim issues and concerns as identified by staff. Quantify and escalate trends and any proposed resolution steps to PFS Manager.
Establish and maintain a professional and collaborative relationship with payers and Inova staff in order to resolve claim edits and payer rejections. Understand Revenue Cycle responsibilities as they pertain to billing functions and communicate with other Revenue Cycle departments to resolve billing issues.
Assist in the development and distribution of, and monitor adherence to, departmental policies and procedures.
Notate all activities and findings in accordance with established policies and procedures to meet quality assurance and documentation standards.
Assist with employee evaluation on an annual or as-needed basis. Assist in creating performance plans, individual goals, and all other supervisory activities as related to billing staff.
Assist in onboarding process for new billing representatives, including review of responsibilities, expectations, and training.
Monitor billing Key Performance Indicators (KPIs) including, but not limited to, Candidate for Billing (CFB), Discharge Not Final Billed (DNFB), and Clean Claims Rate. Assist SBO Billing Department leadership in developing targeted and actionable goals in relation to KPIs.
Maintain ongoing knowledge of UB-04 (or its successor claim form) billing and filing requirements as well as commercial payer billing guidelines. Ensure compliant billing by all staff and escalate issues to PFS Manager, as needed.
Perform related duties as required or as assigned by SBO Billing Department leadership.
Additional Responsibilities and Requirements:
Meet established deadlines, prioritize multiple tasks/assignments, and handle constantly changing work environment.
Adhere to state and federal regulations and Inova Health System policies and procedures pertaining to accurate and compliant billing practices.
Strong interpersonal communication skills with an ability to work both independently and collaboratively as part of a team.
Perform other duties as assigned by SBO Billing Department leadership.
Maintain acceptable levels of attendance and punctuality as outlined in Inova's policies and procedures.
Additional Knowledge / Skills / Abilities:
Effective written and verbal communication skills.
Excellent time management, organizational, and prioritization skills.
Proficient with Microsoft Office programs, including but not limited to Word, Excel, and Outlook.
Strong analytical and critical thinking skills.
Knowledge of Commercial, Managed Medicare, and all other third-party contract structures and billing requirements.
Fluency in medical terminology and billing processes.
Experience with electronic medical records systems. Epic system experience preferred.
Internal Number: 51379BR
About Inova Health System
Inova is a global leader in personalized health, which leverages precision medicine to predict, prevent and treat disease, enabling individuals to live longer, healthier lives. At Inova, we serve more than two million people each year from throughout the Washington, DC, metro area and beyond. Inova's mission is to improve the health of the diverse community it serves through excellence in patient care, education and research. At Inova, more than 16,000 employees demonstrate their commitment every day to providing the community with expert, world-class, compassionate patient care.