Supervisor – Patient Care Services

Supervisor – Patient Care Services

Requirements

• Minimum of 4 years of experience in RCM in or a related field equivalent required.
• Knowledge of healthcare industry, payer relations, and functional compliance regulations and standards required.
• Experience with complex claims processing and/or auditing experience in the health insurance industry or medical health care delivery system required.
• Demonstrated experience leading teams, particularly remote teams and/or teams spanning multiple locations, required.
• Knowledge of standard coding and reference materials used in a claim setting required.
• Knowledge of health care benefit structures and insurance procedures required.
• Knowledge of CMS requirements regarding claims processing, specifically DMEPOS claim processing rules and regulations, required.
• Proficiency in processing/auditing claims for Medicare, Medicaid, and commercial plans required.
• Understanding of business strategies and drivers, particularly in a sales organization.
• Must speak English fluently.

Responsibilities

• Monitors quality and timeliness of outputs of the team and drives a culture of accountability.
• Reviews incoming volumes and assigns appropriate staffing levels need to achieve KPIs.
• Collaborates and partners with cross functional teams ensure Enovis is seen as the premier reimbursement partner to physicians and internal Sales Teams.
• Drives execution and teams to achieve defined KPIs and metrics to decrease cycle time, increase revenue, reduce processing errors, maximize payor and patient cash collections, and control bad debt.
• Conducts business meetings with key stakeholders (DPs, Sales Reps, and FSRs) to advise on business trends and opportunities.
• Actively reviews processes, workflows, and technology to propose opportunities for improvement and eliminate redundancy.
• Identifies, adopts, and shares best practices with RCM Leadership.
• Works closely with internal stakeholders to ensure payor requirements are met.
• Builds and maintains professional relationships with Sales Team(s) across all regions.
• Pursues supporting documentation from Sales Team to ensure all required documents are received prior to invoicing.
• Reviews prescriptions, Letters of Medical Necessity and/or Chart Notes to ensure both completeness and accuracy.

Preferred Qualifications

• Experience with OnBase is strongly preferred.
• Experience using Dataworks, Computers Unlimited TIMS, or similar billing/case management software, strongly preferred.
• Bilingual in English and Spanish strongly preferred.
• Experience with Durable Medical Equipment (DME) or Orthotics reimbursement processing strongly preferred.