Summary:
Manages prior authorization team and our relationship with our external authorization vendor. Works with external billing company and affiliated pain management practices to keep RCM KPIs within benchmark. Identifies patient reimbursement issues, ensuring that claims, denials, and appeals are efficiently processed, and resolves billing-related issues. Works with practices to optimize downstream workflows.
Pay: $70,000 - $80,000 annually.
Essential Duties and Responsibilities:
-
Reports to RCM Director
-
Plans and structures the prior authorization department workflow and staffing
-
Provide analytics and trends regarding front end billing functions
-
Ensures that scrubbing and submission of claims including primary, secondary, and wrap around is occurring daily and that denied claims are being reviewed, corrected, and resubmitted for payment
-
Communicates with the client any issues with credentialing, payer denials, and provider coding error
-
Completes monthly Executive packet for client meetings - includes all relevant and pertinent information as a summary for the past month of billing for the client
-
Prepares for and attends client meetings and conference calls
-
Reviews staff performance logs and identifies performance issues
-
Works with and trains staff to help improve performance
-
Maintains a current knowledge of eCW, Waystar, and Infinx and can assist in the training of new staff on all programs
-
Performs quarterly payer policy reviews and escalates policy changes to providers and staff
-
Monitor prior authorization, medical necessity, frequency and non-covered denials to identify root-cause
-
Obtains the necessary insurance portals for prior authorization staff
-
Performs other related duties as assigned
Supervisory Responsibilities:
-
Manages the prior auth team and eligibility team
-
Manages staff performance by providing regular feedback, performance reviews, and one-on-one meetings
-
Oversees the hiring and training of staff
-
Supervises, trains, and mentors staff respective to front end billing functions
Education & Experience:
-
Bachelor’s degree in Finance, Business Administration, Healthcare Administration, or related field required.
-
Five years of related experience, including three years in a supervisory capacity, required.
Required Skills & Abilities:
-
Excellent verbal and written communication skills.
-
Excellent organizational skills and attention to detail.
-
Strong analytical and problem-solving skills.
-
Proficient with Microsoft Office Suite or related software.
-
Strong leadership and supervisory skills.
-
Proven experience in healthcare billing.
-
Sound knowledge of health insurance providers.
-
Excellent customer service skills.
-
3+ years of eCW experience
-
5+ years of pain management experience
-
2+ years of ASC experience
Physical Demands:
-
Required to sit for long periods.
-
Must be able to communicate with or without reasonable accommodations – speak and hear.
-
Able to use both hands to finger, handle, or feel, and reach with hands and arms.
-
Frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.
-
Specific vision abilities required by this job include close vision, depth perception and ability to adjust focus.
Benefits Of Working At DxTx:
-
100% Remote with great work/life balance culture
-
Safe Harbor 401(k) Match of 100% up to 3% and 50% of the following 2%
-
Benefits With LOW $500 deductible for medical and great employer contribution!
-
Employer Paid Life Insurance and Long-Term Disability
-
Flexible PTO Plan for salary employees!
-
Investment in professional development!
-
Fun work culture with dedicated Culture Club!
-
DAILYPAY AVAILABLE - Apply today and get paid as soon as you work your first shift!
Job Type: Full-time
Benefits:
-
401(k)
-
Dental insurance
-
Health insurance
-
Life insurance
-
Paid time off
-
Vision insurance
Schedule:
-
Day shift
-
Monday to Friday
Experience:
-
eClinicalWorks: 3 years (Preferred)
-
Pain management: 5 years (Required)
-
Ambulatory surgery center: 2 years (Required)
Work Location: Remote
An Equal Opportunity Employer
We do not discriminate based on race, color, religion, national origin, sex, age, disability, genetic information, or any other status protected by law or regulation. It is our intention that all qualified applicants are given equal opportunity and that selection decisions be based on job-related factors.
uoW7Tp8BZ5