Commercial Follow-Up/Denials Supervisor - HB Patient Financial Services - FT Days

Job Description

Overview:

UCI Health is the clinical enterprise of the University of California, Irvine, and the only academic health system based in Orange County. UCI Health is comprised of its main campus, UCI Medical Center , a 459-bed, acute care hospital in in Orange, Calif., four hospitals and affiliated physicians of the UCI Health Community Network in Orange and Los Angeles counties and ambulatory care centers across the region. Listed among America’s Best Hospitals by U.S. News & World Report for 23 consecutive years, UCI Medical Center provides tertiary and quaternary care and is home to Orange County’s only National Cancer Institute-designated comprehensive cancer center , high-risk perinatal/neonatal program and American College of Surgeons-verified Level I adult and Level II pediatric trauma center , gold level 1 geriatric emergency department and regional burn center . UCI Health serves a region of nearly 4 million people in Orange County, western Riverside County and southeast Los Angeles County.

To learn more about UCI Health, visit

Responsibilities:

Position Summary:

Commercial/Managed Care Collection/Denial Manager, the Commercial/Managed Care Collection/Denial Supervisor is responsible for overseeing operations and providing support and guidance to the collection unit. Strong working knowledge of hospital billing and collections of Commercial, Managed Care, Federal/State/County & Self-Funded reimbursement and other programs. As a coach and mentor, provide training, address performance issues, manage compliance, and ensure competency in accordance with established standards, procedures, policies, and legal requirements. Contribute to a work environment that fosters positive morale and ensures compliance. Research and investigate issues as needed, analyze and resolve problems and discrepancies, provide creative solutions, and recommend alternatives and initiatives to optimize performance. Work collaboratively and assist in personnel actions and staffing and human resource matters. Assist in the development of unit goals and objectives and on special projects as needed. Performs routine analysis of various key performance indicators, dashboards, and reports to optimize performance and maintain positive A/R disposition.

Qualifications:

Required Qualifications:

• Strong working knowledge of hospital billing, manage care, fed/state/county & self funded reimbursement
• Strong analytical skills to effectively comprehend multiple reports and analyze array into actionable form
• Strong analytical and report writing skills to effectively comprehend multiple reports and analyze array into actionable form
• Must possess the skill, knowledge, and ability essential to the successful performance of assigned duties.
• Must possess leadership skills. Must be able to identify potential problems and resolve them as needed.
• Must possess effective time management and organization skills
• Must have working experience in billing and collections of Commercial, Managed Care, Medicare, Medicare Advantage, Medi-Cal, CalOptima, FQHC, and CCS, fed/state/county & self-funded reimbursement and other programs that fall under the scope of Comm/Mgd Care programs and commercial billing.
• Must have the ability to maintain a pace appropriate to the workload.
• Must have knowledge of DHMC, Federal and State regulatory guidelines and claims management.
• Must have experience in using computers and related programs (i.e., Microsoft, Excel, Outlook, PowerPoint, etc.).
• Must demonstrate strong technical knowledge of CPT, HCPS and ICD-10 coding, LCD, NCD, MUE, CCI, Modifiers, authorization requirements and related documentation
• Must be able to facilitate accurate and timely billing and collections
• Minimum one( 1) year prior experience leading or overseeing a team.
• Knowledge of Invision, TDS, Access, Excel, Word, HCC, and billing systems
• Excellent oral/written communication, judgement, and decision-making skills with ability to function independently and as a member of a team.
• Excellent oral and written communication skills. Ability to develop summaries/reports on billing activities
• Excellent judgment for decision-making requirements.
• Excellent interpersonal communication skills to communicate effectively with external contacts to include Admissions, Information Systems Management, clearing house vendors, and insurance companies
• Bachelor's Degree and three (3) years of related relevant experience in business office operations, consulting, or auditing; or an equivalent combination of education and experience.

Preferred Qualifications:

• Prior experience with and working knowledge of EPIC electronic health record
• Knowledge of university and medical center organizations, policies, procedures, and forms

Total Rewards

We offer a wealth of benefits to make working at UCI even more rewarding. These benefits may include medical insurance, sick and vacation time, retirement savings plans, and access to a number of discounts and perks. Please utilize the links listed here to learn more about our compensation practices and benefits .

Conditions of Employment:

The University of California, Irvine (UCI) seeks to provide a safe and healthy environment for the entire UCI community. As part of this commitment, all applicants who accept an offer of employment must comply with the following conditions of employment:

• Background Check and Live Scan
• Employment Misconduct*
• Legal Right to Work in the United States
• Vaccination Policies
• Smoking and Tobacco Policy
• Drug Free Environment

Exercise the utmost discretion in managing sensitive information learned in the course of performing their duties. Sensitive information includes but is not limited to employee and student records, health and patient records, financial data, strategic plans, proprietary information, and any other sensitive or non-public information learned during the course and scope of employment. Understands that sensitive information should be shared on a limited basis and actively takes steps to limit access to sensitive information to individuals who have legitimate business need to know. Ensure that sensitive information is properly safeguarded. Follow all organizational policies and laws on data protection and privacy. This includes secure handling of physical and digital records and proper usage of IT systems to prevent data leaks. The unauthorized or improper disclosure of confidential work-related information obtained from any source on any work-related matter is a violation of these expectations.

*Misconduct Disclosure Requirement: As a condition of employment, the final candidate who accepts a conditional offer of employment will be required to disclose if they have been subject to any final administrative or judicial decisions within the last seven years determining that they committed any misconduct; received notice of any allegations or are currently the subject of any administrative or disciplinary proceedings involving misconduct; have left a position after receiving notice of allegations or while under investigation in an administrative or disciplinary proceeding involving misconduct; or have filed an appeal of a finding of misconduct with a previous employer.

The following additional conditions may apply, some of which are dependent upon business unit or job specific requirements.

• California Child Abuse and Neglect Reporting Act
• E-Verify
• Pre-Placement Health Evaluation

Details of each policy may be reviewed by visiting the following page:

Closing Statement:

The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected categories covered by the UC Anti-Discrimination Policy .

We are committed to attracting and retaining a diverse workforce along with honoring unique experiences, perspectives, and identities. Together, our community strives to create and maintain working and learning environments that are inclusive, equitable, and welcoming.

UCI provides reasonable accommodations for applicants with disabilities upon request. For more information, please contact UCI's Employee Experience Center (EEC) at [email protected] or at (949) 824-0500, Monday - Friday from 8:30 a.m. - 5:00 p.m.