Working as the Edits and Billing Supervisor, Patient Financial Services, you will manage and oversee a team responsible for daily operations specializing in the review and resolution of all billing edits preventing claims from being submitted to insurance companies. The PFS Supervisor is responsible for edits and billing within Memorial Health affiliate hospitals including Springfield, Decatur, and Jacksonville Memorial Hospitals.
The PFS Supervisor leads daily operations and technical edit resolution responsibilities to ensure accurate and timely hospital claim payor submissions. Leads the team through continual process workflow streamlining, models and encourages excellent inter and intradepartmental relationship cultivation, and provides training and motivation to achieve the highest level of compliant accelerated cash flow.
Embodies the Memorial Health System Performance Excellence standards of Safety, Quality, Integrity, and Stewardship that support our mission, vision, and values.
Qualifications
Education:
- High school diploma or its equivalent is required.
- Associate’s Degree or two to three years of demonstrated leadership experience in operations, customer service, or related field is preferred.
Experience:
- Minimum of three to five years’ experience as a payment application specialist, or an equivalent combination of experience in a healthcare environment is required.
- Experience facilitating change through team building, processes improvement and multi-disciplinary approach is preferred.
Other Knowledge/Skills/Abilities:
- Demonstrated excellent customer service skills are required.
- Proficiency in Microsoft and departmental applications is required.
- Demonstrated strong oral, written and electronic communication skills as well as analytical and problem- solving skills and ability to multi-task are required.
- Demonstrated ability to work with a diverse group of individuals is required.
- Demonstrated understanding of healthcare, financial, and insurance concepts is required.
Responsibilities
- Embodies the Memorial Health System Performance Excellence Standards of Safety, Quality, Integrity and Stewardship that support our mission, vision and values:
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SAFETY: Prevent Harm - I will put safety first in everything I do. I will speak up, without fear, on matters of patient and colleague safety. I will take action to create an environment of zero harm.
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QUALITY: Improve Outcomes - I will continually advance my knowledge and skills. I will seek out continuous improvement opportunities. I will deliver evidence-based care that leads to excellence in outcomes.
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INTEGRITY: Show respect and Compassion - I will respect others and show compassion. I will behave honesty and ethically. I will be accountable for my attitude, actions and health.
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STEWARDSHIP: Reduce Waste - I will use resources wisely and maintain financial stability. I will work together to coordinate care and services across the health system. I will promote healthier communities.
- Creates schedules for team members, coordinates training and orientation of all new personnel to team, ensures team members’ compliance with all departmental and organizational policies and procedures, and prepares and conducts employee performance evaluations utilizing tools provided. Initiates training and/or corrective actions as necessary.
- Approves/manages the time and attendance system to ensure adherence to schedules and to ensure appropriate staffing levels are met.
- Supervises the daily work of Payment Application Specialists. Oversees day-to-day activities and responsibilities of cash posting team responsible for receipt, posting and reconciliation of all incoming cash payments. Pulling remits from vendor websites, which include 835/EFT posting, insurance checks and personal payments that come thru the mail. Bad debt agency checks, bank loans, payroll deduction payments, NSF, State of Illinois sold vouchers, and intercorporate transactions.
- Acts as a Liaison for General Accounting and Treasury. Responsible for posting all the cash and are needed to help reconcile all items posted to the bank accounts. This consists of 10 bank accounts from different accounting departments. Maintains a daily cash reconciliation sheet used to provide information to general accounting and researches any discrepancies between reconciliation sheet and what was deposited in the bank. General accounting also has an outstanding list that is worked to ensure all deposits are posted.
- Acts as a Liaison for Anesthesia billing. Responsible for pulling their 835’s and EOB’s from MMC and required to FTP to the billing company. Maintains a cash reconciliation spreadsheet to keep track of all payments. Tracks any payments that are comingled with MHS payments.
- Acts as a Liaison for Trubridge which is an outsource company that posts TMH/ALMH payment in their old system CPSI. Researches any posting errors from the vendor and provides any EOB’s. Ensures anything not done by the vendor is done by the cash posting team (payroll, State of Illinois sold vouchers, NSF and credit cards payment).
- Assists team with posting cash when necessary.
- Supervises the daily work of mail correspondence. Which consists of opening incoming mail and routing to the correct person or place. Getting all outbound mail ready to send out and take to the correct location for pickup. Also scanning all EOB’s and work that is done in Cerner Revenue Cycle in Application extender. Assists in scanning issues or looking for EOB’s within Cerner.
- Supervises the daily cash reconciliation process, consisting of balancing daily reports from systems. Verifies balances and ensures balances are in appropriate column on our spreadsheet by entity.
- Investigates and resolves day-to-day operational problems encountered. Works closely with Revenue Informatics team to trouble shoot problems. Assures posting errors are corrected in a timely manner. Stays ahead of technology changes coming with posting and updates to the Cerner platform and assists in testing payments in Dev, Cert, and Production environments.
- Develops and maintains written procedures for working each individual area as guided by department manager.
- Operates within the limits of the staffing budget or demonstrates measures taken to correct.
- Establishes a positive working relationship with all affiliated parties, IT staff and vendor representatives.
- Performs other related work as required or requested.
The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform tasks other than those specifically presented in this description.
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