Insurance Manager (Audibel) Jobs

JOB SUMMARY DESCRIPTION

The Insurance Manager is responsible for the overall oversight and success of the insurance process. This includes securing contracts that are strategically important for our patient care and ensuring providers and locations are appropriately credentialed on all participating plans and payments are accurate based on contracts. Abiding by all governmental and commercial payer regulations, the Insurance Manager oversees the workflow to our insurance staff including managing the Regional Support Specialists team and overseeing our insurance contractors.

Duties job duties include tasks such as processing and filing reports, confirming provider's information with accrediting and licensing agencies and maintaining a database of provider and client information. Tracking payment of claims and accuracy. Managing the insurance team staff. Working with Retail leadership and managers on the overall insurance strategy.

JOB RESPONSIBILITIES/RESULTS

• Maintain existing relationships with contracted providers.
• Provide analysis for all payor agreements to identify improvement opportunities and prioritize contract renegotiations. Evaluate current contracts to market benchmarks.
• Develop and maintain periodic, e.g., bi-weekly, reports on the status of all contracts.
• The position leads the entire contract process from pre-contract through post-signature phases, and closely collaborates with the operations team and internal departments to ensure staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers we serve.
• Assure contractual arrangements meet financial targets and legal/regulatory compliance requirements. There will be an emphasis on analyzing cost and utilization data.
• Manage Regional Support Specialists team and protocols
• Regional Support Specialists coordinate insurance activity between the patient and the office and work with our insurance contractors on benefit investigations, billing, claims processing, collections, and payment posting.
• Assist with login set ups and password resets.
• Assist in auditing bank activities.
• Responsible for the accuracy of supporting documentation for contracts and completing documents accurately in an expediate timeframe and develop and maintain processes that provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements).
• Serve as the main contact for insurance questions from patients and / or staff members.
• Supports Management by providing information, locating data sources and collecting data under tight time constraints.
• Researching territories to identify gaps with our payer base and supporting the expansion into new markets.
• Obtains updated payor fee schedules information from payors.
• Other duties/responsibilities as assigned
• Assist in the development of projected revenue improvements
• Support sales growth by developing new contracts with payers and expanding services with payers that have existing contracts.
• Create queries to pull financial/claims data that will then be used to develop analytical and statistical models to help operations make informed business decisions.
• Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, medical policy changes and reimbursement.
• Development, negotiation, and maintenance of all healthcare contracts.
• Develop management reports to monitor contract performance.
• Handle confidential data.
• Serve as the liaison between health plans and revenue cycle.
• Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy & billing policies.
• Supports Revenue Cycle in contract and fee schedule interpretation.

Results – Performance Measures (How to Measure Success)

• All new hires and acquisitions are credentialed within 120 days of employment.
• All recredentialing occurs before payer deadlines to ensure no provider or location lapse or terms from contracts.
• Customer feedback
• Contracts are obtained, posted, and summarized with timely filing requirements, contract type, billing process, and fee schedules in a central repository.
• Accurate reports and information

Other Duties (Non-Measurable)

• Support Northland Employee Corporate and/or Department Guidelines. Check and verify quality.
• Support corporate health and safety objectives.
• React to change productively and handle other essential duties as assigned.

Job Requirements

Minimum education, certification and experience requirements:

Education:

• BS or BA level degree or equivalent work experience.

Experience:

• 3+ Years Contracting and Credentialing experience with minimum 1 Year leadership experience preferred. Knowledge of DME and specifically hearing aid billing is ideal.

Knowledge

• Expert knowledge of software systems including: Patient management software, Personnel and MS Office Advanced skills in Microsoft Office (all programs)

Skills & Abilities

• Problem Solving
• Verbal and written skills
• Good interpersonal skills required
• Extremely acute organizational skills
• Communication and interpersonal relations
• Work well under pressure and with deadlines
• Numerical Reasoning

Responsibilities

• Oversee Contracting and Credentialing with contractors.
• Exercise of authority or supervision over others:
  • Oversee Contracting and Credentialing with contractors.

Budgetary Responsibilities:

NA

Confidential Information:

Has access to confidential customer and employee information

Required Communication:

External:

Vendors

Patients

Manufacturers

Internal:

All Staff

Work Context

Working Conditions:

Normal office conditions; travel required

Equipment Operation:

Normal office equipment

The above declarations are not intended to be an all-inclusive list of the duties and responsibilities of the job described, nor are they intended to be such a listing of the skills and abilities required to do the job. Rather, they are intended only to describe the general nature of the job.