Managed Vision Care - Billing Operations Supv, Billing Operations

San Antonio, TX, United States

Summary:

The Billing Operations Supervisor is responsible for leading, guiding and training all assigned Billing Operations Team Lead and Associates along with overseeing the day to day activities of the assigned plan revenue cycle. Also responsible for trouble shooting claim rejection issues/trends and performing all Zirmed clearinghouse action items for all plans. Analyze collection of plans based on expected versus paid to proactively reduce write offs and insure maximum reimbursement. Analyze Zirmed reports to ensure claims are being submitted under the proper Tax ID and NPI numbers per the carrier contract.

Pay Class and Pay:

Pay Class: Full Time and Remote

Pay: $21.07- $27.02 Hourly

Essential Responsibilities:

Supervise the team to include selection, training and development, coaching, counseling and performance management.

Manage and oversee Team Lead and Billing Operations Associates along with creating improved processes and workflows to alleviate rejected claims on the first pass.

Monitor Plan paid amounts versus expected amounts with percent of movement (increase or decrease) on a monthly basis. Create and review reports to determine issues that should be escalated to MVC.

Routinely review claim payments using aging and other claim reports, follow up with Claims Processors/ to ensure claims are being submitted, researched and paid timely.

Audit plans to ensure accuracy in plan and provider set up. Determine if there are opportunities to reduce write offs and/or increase collectability for Visionworks.

Partner and communicate with MVC about re-filing claims that were underpaid due to plan/provider set up errors. Use tracking system to follow up on re-filed claims with Contracting Entities, TPB and/or Cash Dept.

Ensure training program is being adhered to so that all direct reports are thoroughly trained and continually updated on submission requirements, procedures, processes and system updates.

Participate in claims exceptions reporting as appropriate.

Other duties as assigned.

Education:

High School Diploma, GED, or equivalent work experience

Associate degree preferred

Experience & Background:

Three (3) plus years' experience in medical insurance claims billing preferred

One to Three (3) years supervisory experience preferred

Proficient in MS Excel and Word

10 key by touch

Experience with implementing claims through an electronic clearinghouse and maintaining it.

Language Skills:

Ability to communicate and resolve issues effectively with others

Ability to establish a good working relationship with all levels of staff

Ability to effectively communicate and promote both verbally and in writing

Well-developed communication skills to gain the trust and cooperation of others when it may be difficult to achieve and ability to communicate technical concepts and abstract ideas

Ability to gather, analyzes, interpret and present data in clear and concise reports and make recommendations

Mathematical Skills:

Add, subtract, multiply, divide, compute rates, rations and percentages

Reasoning Ability

Ability to think logically in following procedures and instructions

Ability to work in a fast paced environment

Highly organized

Detail oriented

Essential Responsibilities related to Physical Demands/Work Environment :

The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the associate is required to stand, use hands and fingers to handle, feel, pick or pinch, and talk or hear most of the time. The associate is occasionally required to stand, walk, and reach with hands and arms. The associate must frequently lift and/or move up to 20 pounds. The noise level in this location is moderate (use of computers, printers and machines).

Activity

Amount of Time

None

Under 1/3

1/3 to 2/3

Over 2/3

Stand

x

Walk

x

Sit

x

Use hands to finger, handle, or feel

x

Reach with Hands and Arms

x

Climb or balance

x

Stoop, kneel, crouch, or crawl

x

Talk or hear

x

Close Vision (clear vision at 20" or less)

x

Essential Responsibilities related to Behavioral Characteristics :

Strong organizational skills and ability to execute manual detailed tasks

Work under stress with interruptions and deadlines

Ability to think logically in following procedures and instructions

Exhibit empathy and good resolution skills

Ability to work onsite and participate in interactive onsite meetings on a regular and predictable basis.

Ability to initiate immediate interaction, coordination and collaboration with team members, clients, customers etc.

HIPAA & Security Requirements

All Associates must comply with the Health Insurance Portability Accountability Act of 1996 (HIPAA) as it pertains to disclosures of protected health information (PHI) as described in the Notice of Privacy Practices and HIPAA Privacy Policies and Procedures. As a component of job roles and responsibilities, Associates may have access to covered information, cardholder data or other confidential customer information which must be protected at all times. As a result, Associates must explicitly adhere to all data security guidelines established within the Company's Privacy & Security Training Program.

Visionworks is an equal opportunity employer, committed to the hiring, advancement and fair treatment of individuals without regard to race, color, religion, sex, age, sexual orientation, gender, national origin, ethnicity, disability or veteran status, or any other protected status designated by federal, state or local law.

The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to perform the job successfully. As required by changing business needs, complete additional essential responsibilities as identified and assigned.

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