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Reimbursement Section Supervisor

Reimbursement Section Supervisor (RSS) is responsible for review and resolution of overpayments on patient accounts and supervision of the day-to-day activities of the Reimbursement staff. Supervisory duties include, but are not limited to:  interviewing, training and development, performance monitoring, and staff evaluations. As the supervisor, the RSS is responsible for the management, control, and reporting of overpayment balances. The RSS is responsible for analyzing data to identify the causes and types of overpayments and is responsible for communicating those findings to other departments in an effort to reduce overpayments. In addition, the RSS will be responsible for the following: 1) updating and maintaining the print version of the fee schedules for the Clinics, 2) for supervising the Medical Records function. The RSS will perform other duties related to reimbursements as assigned by the Supervisor.

Work Hours:

A 40 to 45-hour workweek, Mon-Fri, 8:00 a.m. to 5:00 p.m. is normal. Variations to this work schedule may be required.

Education & Training:

  • Must have High School diploma or GED
  • Must have one of the following:
    • 4 years experience in an accounting or related position
    • Certificate from vocational school plus 2 years experience in an accounting or related position
  • 1 year leadership/supervisory experience preferred

Driver and Reimbursement Requirements:

A valid state driver’s license, personal vehicle, vehicle insurance and a good driving record are required.  Position requires travel and is authorized for mileage reimbursement.

Essential Knowledge, Skills & Abilities:

  • Must possess good customer service skills
  • Must possess effective reasoning and deductive ability
  • Must be able to work in team environment, as well as independently
  • Must be able to communicate effectively in English (grammar, spelling, writing, verbal skills);
  • Must be able to read, correctly interpret and follow written guidelines/protocols
  • Must be able to learn and apply new skills
  • Must be able to direct and evaluate performance of staff
  • Must be able to prioritize multiple tasks to work efficiently
  • Must be able to effectively manage and remit overpayment balances
  • Must be organized, detail oriented and able to adapt quickly to stressful work environment
  • Must have the ability to use personal initiative for self-direction of work projects
    • Must have understanding of accounting and billing policies and procedures
  • Must consistently exhibit mature and tactful attitude
  • Must maintain confidentiality when dealing with medical information
  • Must understand medical terminology, its spelling and abbreviations
  • Experience using a 10-key adding machine preferred
  • Medical software experience required; current TMC medical software experience preferred
  • Ability to communicate in Spanish helpful

Position Advancement:

The RSS position has an opportunity for advancement to RSS II based on additional education.  Upon completion of the requirement of an undergraduate degree, the RSS will become an RSS II.  The degree must be in Healthcare Administration, Business or a related field to be approved by the Human Resources Director (HRD).

Essential Job Functions & Duties:

  1. Maintains effective verbal, written and listening communication with staff and superiors
  2. Screens applications, resumes and testing; interviews and makes recommendations regarding potential employees
  3. Communicates performance expectations to new and existing staff and provides on-going feedback (both positive and negative)
  4. Actively conducts or closely monitors others that conduct new employee orientation and training
  5. Assigns job responsibilities
  6. Supervises and evaluates employee performance
  7. Conducts and documents scheduled meetings with staff to allow performance “barriers” to be discussed and resolved
  8. Continually develops staff by providing on-going training to maintain or enhance employee skill level
  9. Identifies the need for corrective action plans, develops a plan with supervisor’s assistance and follows plan with adequate documentation
  10. Completes and presents employee evaluations by due date
  11. Maintains time and attendance records for assigned staff
  12. Presents attendance memos within 7 days of receipt of weekly attendance reports
  1. Supervises, monitors and serves as backup to staff in the performance of overpayment duties
  2. Reviews and approves all refund requests identified by the Reimbursement Specialist (RS)
  3. Reviews and approves all pending recoupment requests processed by RS
  4. Reviews and approves all conveyance transactions prior to posting
  5. Reviews refund reports and provides direction to reimbursement staff
  6. Resolves all disputed reimbursement claims with employers, carriers or patients
  1. Adds approved new codes to all applicable fees schedules with correct fee, allowed and options
  2. Updates and distributes printed fee schedule as fees change
  3. Uses medical software reports to identify potential corrections to allowable amounts that cause patient overpayments
  1. Monitors reimbursement processes on an on-going basis, recommend changes or revisions as needed
  2. Performs routine reviews of staff’s work to identify areas of strength or weakness and recommends corrective processes as needed
  3. Oversees implementation of new or improved processes in department
  4. Documents complaints with full descriptions and recommendations for solutions and forwards to supervisor
  1. Identifies recurring causes of overpayments and develops suggestions to reduce number of overpayments
  2. Notifies other departments of findings related to overpayments
  3. Works with insurance carriers, employers and TMC employees to reduce overpayments
  4. Documents issues in patient accounts
  5. Maintains record of problems and status of resolution
  1. Ensures that the 7-day response target is met
  2. Ensures that requests for Medical Records are logged daily and that pending requests are updated
  3. Ensures that the type of requested records are identified
  4. Ensures that invoices for medical record services are created and mailed
  5. Ensures that subpoenas, depositions and affidavits are processed
  6. Ensures that requests for medical records are delivered (after payment is received)
  7. Ensures that Medical Records are presented into evidence in court as required by law
  8. Ensures that paper or electronic documentation of records provided is maintained
  1. Ensures that the ASAP to 7 day deadline is met
  2. Ensures that clinic requests are received by phone or email
  1. Ensures that Medical Records are pulled, copied and re-filed from Billing Office or record storage
  2. Ensures that Medical Records are sent
  1. Interacts with staff members professionally
  2. Follows company policies and procedures (time and attendance, appropriate attire, etc)
  3. Correctly uses office equipment
  4. Performs work in a safe manner
  5. Other duties as assigned
  6. Must be punctual and reliable in attendance

Customer Service Skills:

  1. Answer questions from internal and external customers in a professional manner
  2. Respond to requests from internal and external customers in a professional manner
  3. Meets the service expectations of patients
  4. Resolves problems identified by patients
  5. Meets the service expectations of internal customers
  6. Resolves problems identified by internal customers
  7. Meets the service expectations by external customers
  8. Resolves problems identified by external customers
  9. Follows through on commitments
  10. Interacts with co-workers in other departments in a manner that promotes teamwork and facilitates company goals

Working Conditions & Risks:

Work is indoors in a well lighted, and seasonally heated and cooled business office. Job hazards are estimated to be minimal (low risk).  Potential risk exists from accidents while using routine office equipment.

Physical Requirements:

Position requires occasional need to lift heavy (30-50lbs) boxes from chest height to floor to chest height.  Prolonged sitting, sorting, moving about, and intermittent typing approximately 4-6 hours per day routinely. Good vision, good hearing, and clear speech required (correctable). Repetitive motions consist of extended periods of upper body and upper limb movements (arms, hands, and wrists).

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