Supervisor - Patient Billing and Revenue Reconciliation

JOB SUMMARY:

The Supervisor - Patient Billing and Revenue Reconciliation is responsible for overseeing the timely submission of claims to the National Health Insurance Company and other insurance providers. The incumbent works closely with clinical departments and payers to ensure proper documentation and timely transmittal of information both ways. The Supervisor - Patient Billing and Revenue Reconciliation on regular basis, checks and validates all open claims and makes the necessary decisions based on approved policies and procedures. The Supervisor - Patient Billing and Revenue Reconciliation  functions as a resource to the revenue cycle team and other departments when it comes to insurance and claims processing issues.

KEY ROLE ACCOUNTABILITIES:

• Recommends solutions to Manager - Accounts Receivable and Revenue Analysis on posting adjustments to patient accounts.
• Anticipates future issues and suggests recommendation with regard to processing write-offs in accordance with delegated authorities.
• Responsible for the overall efficiency of the Insurance verification and eligibility function of the Division.
• Oversees claims submission by billers.
• Preparation of revenue reports on the billing and reimbursement status of all insurance patients.
• Raises with higher management any outstanding issues with producing bills in a timely manner.
• Ensures zero loss of revenue due to billing delays.
• Addresses complaints and resolves issues and problems in a timely and effective manner. 
• Acts as the primary interface with other departments regarding all matters pertaining to insurance verification and eligibility.
• Performs scrubber function and advises the team for posting adjustments and corrections on the system.
• Utilizes Cerner Charge Services to produce and submit claims.
• Ensures timely payment processing by following up on submitted claims.
• Liaises with insurance providers or TPAs on regular basis.
• Monitors unpaid and partially paid claims and takes the necessary steps for appeal or resubmission.
• Resubmits claims as necessary with detailed investigation regarding the claims.
• Manages and monitors patient related liabilities with the AR Section for processing.
• Performs account reconciliation functions based for received remittance advices from insurance providers. 
• Prepares and posts claims adjustments as required.
• Manages patient billing system setups in Cerner Patient Billing system.
• Ensures accurate accounting records are maintained in Cerner Patient Billing System.
• Maintains Oracle to Cerner Mapping and ensures updates are captured effectively.
• Ensures timely submission of claims and liaises with the insurance providers for their payment.
• Analyzes, investigates and resolves outstanding discrepancies in claims processing and refers unresolved cases to the Manager - Accounts Receivable and Revenue Analysis.
• Analyzes, recommends and processes write-offs in accordance with delegated authority.
• Reviews accounts for possible assignment and forwards information to the AR section for collection.
• Ensures the accurate preparation of claims submissions and reconciliations reports on regular basis.
• Prepares monthly claims and aging reports and responds to inquiries related to claims processing.
• Participates in monthly closing meetings.
• Identifies areas for improvement and shares them with the Business support team.
• Maintains working documents in accordance with internal record keeping standards.
• Adheres to Sidra’s standards as they appear in the Code of Conduct and Conflict of Interest policies
• Adheres to and promotes Sidra’s Values

QUALIFICATIONS, EXPERIENCE AND SKILLS:

• 5+ years’ of experience in revenue cycle in a 100+ bed facility inclusive of 2 years of progressive supervisory experience
• Experience in electronic billing systems

• Working experience with Cerner Patient Accounting
• Regional experience working with health insurance providers in the Middle East

• Demonstrated knowledge and skills with patient billing systems
• Demonstrated ability to manage claims processing with patient insurance operations
• Demonstrated ability in verifying and ensuring claims eligibility verification Processes, basic health data and procedures
• Proficiency with Microsoft Office suite
• Fluency in written and spoken English

• Working with Cerner Patient Billing Application
• Knowledge of CPT, ICD-10-AM, ACHI Coding and medical terminologies