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Work Shift

Day (United States of America)

Job Summary:\rThe Insurance Cash Apps Lead ensures that all posting staff are assigned daily work, all staff DPL's are reviewed for productivity purposes, and quality assurance protocol is followed and communicated to the team. Third-party accounts are reviewed and that all payor sources remit payment in a timely manner (reviews missing payments, download electronic remits, etc.). This position provides leadership and direction for all professional payment posting functions to ensure financial viability.These functions include researching and posting of all insurance payments received. Management skills are required in the daily operations of assigned area. It is imperative to maintain a good working relationship with physicians, management, staff, and external contacts such as insurance representatives. The Lead MGBO Insurance Cash Posting position requires the use of independent judgement and decision making; as well as strong analytical, problem solving, and leadership skills. Internal contacts include all levels of staff and management, including physicians, management, and staff. External contacts include insurance companies, state and federal agencies, outside accounting firms and auditors; resolving problems and issues, and discussing sensitive and confidential information.\rCore Responsibilities and Essential Functions:\rPrimary Responsibilities\r* Transmit required documentation to third-party payors for the purpose of resolving payments.\r* Ensure all payor contact is fully documented in the appropriate software application.\r* Monitor payments for accuracy and timeliness, contacting payors to resolve outstanding amounts and reporting ongoing problems and issues to the unit supervisor.\r* Recommend accounts for contractual or administrative write-off, along with appropriate justification and documentation.\r* Meet productivity standards, targets, error ratios, and reporting requirements as assigned by the department manager or supervisor.\r* Provide individual contribution to the overall team effort of achieving the department AR nd posting goal.\r* Identify opportunities for system and process improvement and submit to management.\r* Demonstrate proficient use of systems and execution of processes in all areas of responsibilities.\r* Demonstrate knowledge of HIPAA privacy standards and ensure compliance with system PHI privacy practices.\r* Follow the WellStar general Policies and Procedures, the Departments Policies and Procedures, and the Emergency Preparedness Procedures.\r* Follow JCAHO and outside regulatory agencies mandated rules and procedures.\r* Utilize assigned menus and pathways in the hospital mainframe system and report software application problems to the appropriate supervisor.\r* Utilize assigned menus and pathways in foreign software applications and report software application problems to the appropriate supervisor.\r* Utilize assigned computer hardware and report hardware problems to the appropriate supervisor.\r* Participate in the testing for assigned software applications, including verification of field integrity.\r* Develop and maintain positive working relationships with third party payers to facilitate the resolution of issues and expedition of payments.\r* Develop and maintain positive working relationships with third party payers to facilitate the resolution of issues and expedition of payments.\rOther Lead Functions\r* The Insurance Cash Apps Lead ensures that all posting staff are assigned daily work, all staff DPLs are reviewed for productivity purposes. (Productivity Goals detailed in Productivity policy)\r* Monthly quality review of payment posters. (Quality Assurance Goals detailed in QA policy) The findings will be communicated to the staff by the Team Lead or Manager for review and/or correction. A copy will be maintained in the department employee file.\r* Training/Assistance Goal: Provide initial and ongoing training for all Payment Department staff. The Lead will provide additional training as needed based on the Quality Assurance Reports. Assist staff with questions and/or problems as a priority to limit any delay in productivity. Measurement: Procedures and job aids will be reviewed with each staff member indicating that a poster has working knowledge and understands each function. The Quality Assurance report will also assist in determining if the staff has been adequately trained.\r* Transactions Goal: Insurance deposits (EFT/Lockbox) and Zero EOBs not posted to Legacy systems are less than or equal to 1 business day at month end. Measurement: The Daily Deposit Totals Report for the month will provide deposit totals at month end.\r* Payment research received from payment posters and other departments.\r* Cross train staff in payment posting functions (i.e. electronic, lockbox, reports)\r* Verify receipt of and distribute 835 posting files.\r* Assist with payment posting\r* Trouble shoot payer payment issues with payer provider representatives\r* Unposted cash monthly average according to current KPI\r* Assist in developing and maintaining policies, procedures, job aids and staff training.\r* Perform other duties and responsibilities as assigned\rSupervision\r* Perform all supervisory functions of selected Payment Posting I and/or 2 representatives.\r* Act as a mentor to Insurance Payment Posting representatives.\r* Provide guidance to Insurance Payment Posting representatives.\rProfessional Communication\r* Maintain confidentiality in matters relating to patient/family.\r* Assure patient privacy and confidentiality as appropriate or required.\r* Ensure minors have a parent or guardian listed as guarantor as appropriate.\r* Interact with patients/families with a variety of developmental and sociocultural backgrounds.\r* Provide information to patients and families to reduce anxiety and convey an attitude of acceptance, sensitivity, and caring.\r* Maintain professional relationships and convey relevant information to other members of the healthcare team within the facility and any applicable referral agencies.\r* Initiate communication with peers about changes and procedures.\r* Relay information appropriately over telephone, email, and other communication devices.\r* Interact with internal customers including HIM, Revenue Integrity, Patient Access, and the SBO in a professional manner to achieve revenue cycle department AR goals and objectives.\rTeamwork\r* Assist with special projects as assigned.\r* Work closely with other staff, co-workers, peers, and other members of the healthcare team to ensure a positive and effective work environment.\r* Report to appropriate personnel regarding assignments, projects, etc.\r* Initiate problem solving and conflict resolution skills to foster effective work relationships with peers.\r* Report to work on time and as scheduled.\rProfessional Development\r* Attend staff meetings, in-services, and continuing education.\r* Assist in the development of indicators, thresholds, study methods, and data collection as assigned.\r* Respond to problems/opportunities to improve care/customer service.\r* Support involvement in system performance improvement initiatives.\r* Participate in and maintain competencies required for the position and specific unit/area(s) of assignment.\rPerforms other duties as assigned\rComplies with all WellStar Health System policies, standards of work, and code of conduct.\rRequired Minimum Education:High School Diploma General or GED General\r\rRequired Minimum License(s) and Certification(s):\rAll certifications are required upon hire unless otherwise stated.\rAdditional License(s) and Certification(s):\rRequired Minimum Experience:\rMinimum 4 years work experience in healthcare automated cash applications Required\rRequired Minimum Skills:\rSkill in problem solving in a variety of settings.\rSkill in motivating and directing the work and activities of staff with the ability to effectively delegate.\rSkill in technical and professional accounting.\rSkill in good oral, writen, and interpersonal communication, grammar, and spelling.\rSkill in time management and project management.\rStrong understanding of 835 Remittance Files functionality.\rStrong understanding of Clearing House vendor management from a Payment Perspective.\rAbility to work cooperatively in a team environment.\rAbility to set climate for performance at optimum levels.\rAbility to establish and maintain a cohesive work team.\rAbility to work efficiently under pressure.\rAbility to apply appropriate leadership techniques in an operational setting.\rAbility to work independently and take initiative.\rDemonstrates a commitment to continuous learning and to operationalize that learning and top operationalize that learning.\rAbility to willingly accept responsibility and/or delegate responsibility.\rAbility to deal effectively with constant changes and be a change agent.\rAbility to deal with difficult people and/or difficult situations effectively.\rAbility to set priorities and use good judgement for self and staff.

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