Manager of Insurance Follow-up & Appeals

Position Summary

The Manager of Insurance Follow-Up and Appeals reports directly to the Revenue Cycle Director and is responsible for oversight of client accounting functions for insurance clients. The Manager of Insurance Follow-Up and Appeals helps improve cash flow and participates in managing the overall health of the company’s receivables.

Relationships and Contacts

Within the organization: Initiates and maintains frequent and close working relationships with staff, and peers throughout the organization.
Outside the organization: Maintains working relationships with community partners, health insurance companies, prospective and current client as well as company vendors.

Position Responsibilities

Essential Responsibilities

1. Provides leadership, supervision, ongoing feedback and coaching for team members within client accounts reporting alignment.
2. Supports preparation of daily census reporting.
3. Supports month-end processes for assigned facilities and areas of responsibility.
4. Ensure accurate, timely and complete client account follow-up.
5. Ensures adequate staffing coverage is consistently in place, including time off coverage.
6. Confirm accounts are processed to completion to resolution.
7. Documents all activity taken on an account in the client account notes.
8. Effectively identifies and brings forward trends that inhibit timely payment.
9. Confirms claims are processed within the established productivity standards, for timely follow-up maintaining and updating all patient accounts to reflect current information.
10. Reviews accounts for accuracy including account balance, payer plan and financial class, level of care, denials, and insurance requests.
11. Understands and interprets insurance explanation of benefits, knowing when and how to ensure that payment has been received.
12. Responds in a professional and timely manner to all billing-related inquiries from patients, guarantors, staff and payers.
13. Understands authorizations and limits to coverage such as the number of authorizations/units.
14. Documents, analyzes, and trends billing and collection activities and communicates to supervisor as appropriate.
15. Coordinates with facilities and medical records for resolution of disputed/denied claims and monitoring of the appeals and medical record claims.
16. Directly manages the Insurance Collections Supervisor.
17. Trains team members on new and updated processes.

Additional Responsibilities

1. Provide support on special or large analysis projects, as assigned.
2. Performs other duties, as assigned.

Minimum Requirements

Education and Experience

Position requires a high school diploma or equivalent, bachelor’s degree preferred. Must have a minimum of three (3) years’ experience with insurance billing and collections, and a minimum of three (3) years of supervision experience, preferably within behavioral healthcare.

Physical Requirements

• While performing the duties of this job, the employee will be required to communicate with peers/general public, clients and/or vendors
• Job performance will require the ability to move throughout the building as well as sit or remain stationary for extended periods of time
• While performing the duties of this job, the employee may be required to talk or hear, sit, stand, or walk.

Skill Competencies

• Demonstrates strong problem solving and analytical skills
• Demonstrates excellent customer service
• Demonstrates the ability to communicate effectively with companies, clients and families
• Demonstrates a strong understanding of revenue cycle management
• Demonstrates a high level of follow through
• Demonstrates excellent verbal and written communication
• Demonstrates the ability to exercise sound judgment and discretion
• Demonstrates excellent organizational and time management skills
• Demonstrates excellent interpersonal and relationship building skills
• Demonstrates the ability to prioritize and transition quickly between tasks
• Demonstrates proficiency with Microsoft Office programs