Web Systems Manager jobs in Texas

Position Title: Arbitration Manager

Reports To: Director A/R & Compliance

Position Summary:

The arbitration manager oversees and delegates work to the arbitration team.The seasoned professional for this job needs superior communication and computer skills including familiarity with Microsoft Outlook, Word and Excel. This individual specializes in the resolution of arbitration negotiations, schedule arbitration teleconferences, and performs a wide variety of tasks such as generating reports, correspondence, and setting up informal offers.The manager of Arbitration and Web Systems is responsible for the overall supervision of the reimbursement team by monitoring the status and updating progress on arbitration and negotiation projects. The director is expected to perform in accordance with all policies and procedures, follow standards for ethical business conduct, and serve as a positive role model for the team.

Duties and Responsibilities include, but are not limited to the following:

• Analyze claim reports to determine claims eligible for Arbitration for both ERISA/NSA claims as well as state insurance department claims
• Prepare claims for submission to the appropriate portals for arbitration
• Have the ability for re-prioritizing key tasks and meet with director to provide updates of findings and outcomes
• Work with external vendors such as State Department of Insurance (DOI) personnel and arbitrators to assist with issues and resolutions
• Complete special projects and other duties as assigned
• Prepares and analyze the IDR, Arbitration, and Informal Teleconference process
• Maintains contacts with other departments to obtain and analyze additional patient information to document and process billings.
• Prepares and analyzes accounts receivable reports, weekly and monthly financial reports, and insurance contracts with Director of AR. Collects and compiles accurate statistical reports.
• Audits current procedures to monitor and improve efficiency of billing and collections operations.
• Ensures that the activities of the billing operations are conducted in a manner that is consistent with overall department protocol, and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.
• Participates in the development and implementation of operating policies and procedures.
• Reviews and interprets operational data to assess the need for procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency.
• Oversees efficiency of the arbitration emails.
• Oversight of USMON arbitration tracking, in addition to tracking in arbitration spreadsheet.
• Analyzes trends impacting charges, coding, collection, and accounts receivable and takes appropriate action to realign staff and revise policies and procedures.
• Keep up to date with carrier rule changes and distribute the information within the practice.
• Understands and remains updated with current coding and billing regulations and compliance requirements.
• Maintains a working knowledge of all health information management issues such as HIPAA and all health regulations.
• Maintains library of information/tools related to documentation guidelines and coding.
• Supervises arbitration personnel, which includes work allocation, training, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance.
• Provides, oversees, and/or coordinates the provision of training for new and existing billing staff on applicable operating policies, protocols, systems and procedures, standards, and techniques.
• Coordinates team member time off in a manner that does not negatively impact necessary daily functions.
• Conducts employee relation functions such as: interviews, hiring, 1:1, termination, reviews, and coach ups.
• Performs other miscellaneous job-related duties as assigned.

Enrollment Responsibilities:

• • In-depth knowledge and understanding of the entire enrollment process.
  • EDI enrollment within Waystar and other portals.
  • Maintain multiple payer portals to ensure timely enrollment of EFT’s (Electronic Funds Transfers) to validated bank accounts.
  • Maintain multiple payer site set ups for each account to ensure timely enrollment for ERA delivery to correct account clearinghouse.
  • Accuracy of information when completing all submitted enrollment forms that contain bank account data.
  • Utilizing and maintaining multiple account EFT & ERA setups for multiple payer websites.
  • Facilitate enrollment of EFTs ERAs in addition to portal access
  • Track and follow up with payer’s intermediaries to ensure timely completion of all enrollments.
  • Facilitate resolution of payer approvals and denials
  • Follow up with missing EOBs when an EFT is received and ensuring that the account is set up for future EFTs.
  • Prioritize multiple tasks and projects under aggressive time constraints.
  • Perform other duties and/or projects as assigned by Management within the area of responsibility and control.
  • Stay abreast of coding changes and updates to reimbursement guidelines per EOB explanations and inform Management.
  • Manage the Employee Access Sheet by updating passwords and access to portals.

Requirements and Skills:

• • Strong computer skills including Microsoft Office with a strong ability in Excel spread sheets, using formulas, pivot tables, filters, etc.
  • Strong organizational, analytical, and problem-solving skills
  • Knowledge of the insurance industry
  • Professionalism in all dealings, both internal and external
  • Ability to clearly communicate, both verbally and in writing
  • Knowledge of medical terminology

Experience and Training:

• Minimum of 5 years in Medical Billing/Revenue Cycle Management
• Knowledge of CPT Codes
• Knowledge of HIPAA Laws

Physical Demands:

• Ability to lift a maximum of 25 pounds
• Ability to sit for long periods of time