Appeals Supervisor (Remote)

TeamHealth is named among the “150 Great Places to Work in Healthcare” by Becker’s Hospital Review and has ranked three years running as “The World’s Most Admired Companies” by FORTUNE Magazine as well as one of America’s 100 Must Trustworthy Companies by Forbes Magazine in past years. TeamHealth, an established healthcare organizations is physician-led and patient-focused. We continue to grow across the U.S. from our Clinicians to our Corporate Employees and we want you to join us.

• Career Growth Opportunities
• Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
• 401K program (Discretionary matching funds available)
• GENEROUS Personal time off
• Eight Paid Holidays per year
• Quarterly incentive plans

*This is a fully remote position, supporting our Akron, OH Billing Center*

JOB DESCRIPTION OVERVIEW:

Reports to the Accounts Receivable Manager and performs direct personnel supervision and management of the employees in the Appeals Department. Management duties are pursued with the orientation that the department personnel deserve fair and honest leadership, effective training and specific performance goals. Operational responsibilities are pursued with the orientation that the employer deserves effective management of personnel, cost-efficient planning and appropriate adherence to company policies and management philosophies.

Originates, implements, supervises and facilitates department activities to achieve optimal performance, quality and productivity.

Broad areas of responsibility include, but may not be limited to: Personnel Management, Data Quality Management, Productivity Management, Billing Management and Communications and other activities as assigned.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Manages and supervises the Appeals Representatives in the functions of reviewing invoices containing claim denials.
• Monitor ETM Daily PIT reports to ensure assigned invoices are being properly assigned, reviewed and resolved.
• Partners with HR to maintain job descriptions, conducts performance evaluations, recommends salary increases and initiates appropriate disciplinary action when required.
• Responsible to document and communicate employee issues to include but not limited to employee behavior, performance, quality and productivity with timely escalation to management as appropriate.
• Staffs and maintains adequate levels of personnel according to the staffing plan.
• Determines training needs for Denials & Appeals Representatives and provides planned training agenda for new Analysts.
• Analyzes system data and denial reports and makes recommendations to improve processes as needed.
• Evaluates carrier requirements and formulates a denials resolution strategy.
• Consults with Accounts Receivable Manager to prioritize the working of denials and maintains current denials and appeals to meet Team Health standards.
• Monitors work of team members, maintains effective personnel relations, and ensures that goals are achieved.
• Works with other Denials Supervisors to improve the denials resolution processes across Billing Centers.
• Manages department within budget guidelines.
• Conducts weekly Denials & Appeals meetings and participates in Accounts Receivables/Operations meetings.
• Communicates recommendations to Operations on how to improve front end processing to alleviate accounts receivable issues.
• Communicates and follows-up internal needs/claims requirements to Clerical Support and Software Applications.

Job Requirements: