Director, Insurance Accounts Receivable

Job Description

Job Description

Description:

We offer competitive pay as well as PTO, Holiday pay, and comprehensive benefits package!

Benefits:

· Health insurance

· Dental insurance

· Vision insurance

· Life Insurance

· Pet Insurance

· Health savings account

· Paid sick time

· Paid time off

· Paid holidays

· Profit sharing

· Retirement plan

GENERAL SUMMARY

The Director, Insurance Accounts Receivable will lead a team of internal team members and outsourced business partners responsible for the timely and efficient follow-up on insurance receivables. This role will ensure the prompt payment of claims, including denials, claims without response, and partial payments. The Director will oversee the Adjustment Request and Approval application, report and analyze denial rates, and provide strategic direction to optimize the Insurance AR follow-up process. They will work closely with RCM, operations, and clinical teams to enhance the claim payment and minimize insurance AR backlogs.

The Director will lead by example a team of 6 managers and approx.. 35 FTE’s in ensuring that all insurance receivable balances are delegated to the appropriate resource, all appeals and denials are handled effectively and timely, and opportunities for improvement are identified and executed. Additionally, the Director will optimize the use of technology to improve efficiencies, reduce manual effort, and support timely collections.

ESSENTIAL JOB FUNCTION/COMPETENCIES

The responsibilities and duties described in this job description are intended to provide a general overview of the position. Duties may vary depending on the specific needs of the affiliate or location you are working at and/or state requirements. Responsibilities include but are not limited to:

• Manage a team of internal staff and outsourced business partners to ensure timely follow-up on all insurance receivables, including denials, claims with no response, and partial payments.
• Ensure that the AR follow-up process is executed efficiently to prompt payment of claims, meeting organizational goals for aging accounts.
• Delegate follow-up tasks to ensure that the most difficult AR cases are handled by the most experienced team members.
• Develop standard operating procedures and protocols for insurance AR follow-up, with a particular focus on managing payer-specific and service line specific issues and claims challenges.
• Oversee the adjustment approval process, ensuring that approvals are obtained promptly, and adjustments are posted in a timely manner.
• Monitor any backlog of adjustments and ensure that any lagging approvals are resolved quickly to avoid delays in the payment cycle.
• Develop and implement standard protocols for addressing major types of denials by payer, ensuring consistency and thoroughness in all follow-up efforts.
• Track denial rates and identify trends, providing relevant feedback to the charge capture and upstream RCM teams to enhance charge scrubber edits, billing practices, and coding accuracy.
• Identify and address improper payer behavior using strategic escalation tactics to ensure timely resolution of claims.
• Track payer issues by TIN and payer, documenting improper payer behavior and working with the payer to correct issues.
• Create a culture of proactive payer communication to resolve issues quickly and reduce future denials or delays in payments.
• Ensure that standard appeal letters and letters of medical necessity are created and standardized for maximum effectiveness at the first level of appeal.
• Ensure that all levels of appeal are exhausted with the payer and that appropriate follow-up is performed for unpaid or improperly adjudicated claims.
• Determine the effectiveness of implementing a patient approved grievance process in the event that appeals are not effective.
• Optimize the use of technology, including PWK segments and electronic tools, to drive efficiency and expedite claims follow-up and collections.
• Implement and manage the use of auto claims status tools to supplement manual AR follow-up efforts, assessing ROI and effectiveness.
• Work closely with IT and operations teams to further automate processes, including the posting of adjustments and approval workflows.
• Develop, communicate, and report on key production and quality metrics for the Insurance AR Follow-Up team to ensure that goals are met and high standards are maintained.
• Monitor and assess performance regularly, identifying opportunities for improvement and providing feedback to team members.
• Regularly track AR aging trends and implement corrective actions to ensure that accounts are followed up on promptly and efficiently.
• Develop and implement a secondary balance rebilling strategy to promote the payment of lower-dollar, higher-volume claims.
• Monitor the effectiveness of the secondary rebilling strategy and adjust as necessary to improve recovery rates.
• Manage insurance master files, and payer portals, ensuring that payer information is accurate and up to date.
• Monitor payer portal activity and ensure that the portal is being utilized effectively to resolve claims and minimize AR aging.
• Collaborate with RCM, operations, clinical teams, and other stakeholders to resolve insurance-related issues and improve overall revenue cycle performance.
• Provide regular feedback on payer behaviors, claim trends, and denial patterns to inform business decisions, workflow adjustments, and process improvements.
• Performs other position related duties as assigned.
• Employees shall adhere to high standards of ethical conduct and will comply with and assist in complying with all applicable laws and regulations. This will include and not be limited to following the Solaris Health Code of Conduct and all Solaris Health and Affiliated Practice policies and procedures; maintaining the confidentiality of patients' protected health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA); immediately reporting any suspected concerns and/or violations to a supervisor and/or the Compliance Department; and the timely completion the Annual Compliance Training.

CERTIFICATIONS, LICENSURES OR REGISTRY REQUIREMENTS

• N/A

KNOWLEDGE | SKILLS | ABILITIES

• Strong knowledge of insurance claims processing, denials, adjustments, and appeals, as well as payer policies and practices.
• Experience with insurance master file management, payer portals, and AR systems.
• Proficiency in using technology to drive efficiency, including tools such as PWK segments, auto claims status tools, and electronic adjustment posting systems.
• Strong problem-solving skills, with the ability to identify issues, implement solutions, and optimize processes for improved performance.
• Excellent communication and interpersonal skills, with the ability to collaborate effectively across departments and with external partners.
• Ability to analyze and interpret data to make informed decisions and report on performance metrics.
• Ability to work in an office setting and on a computer for extended periods of time.

EDUCATION REQUIREMENTS

• Bachelor’s degree in Healthcare Administration, Business Administration, Finance, or related field; Master’s degree preferred. Relevant experience may be considered in lieu of a degree.

EXPERIENCE REQUIREMENTS

• 7+ years of experience in revenue cycle management, with a focus on insurance AR follow-up, denials management, and payer relations.
• Minimum of 5 years of experience in a leadership role, managing a team in an AR follow-up or claims resolution capacity.

REQUIRED TRAVEL

• Occasional travel may be required.

PHYSICAL DEMANDS

Carrying Weight Frequency

1-25 lbs. Frequent from 34% to 66%

26-50 lbs. Occasionally from 2% to 33%

Pushing/Pulling Frequency

1-25 lbs. Seldom, up to 2%

100 + lbs. Seldom, up to 2%

Lifting - Height, Weight Frequency

Floor to Chest, 1 -25 lbs. Occasional: from 2% to 33%

Floor to Chest, 26-50 lbs. Seldom: up to 2%

Floor to Waist, 1-25 lbs. Occasional: from 2% to 33%

Floor to Waist, 26-50 lbs. Seldom: up to 2%