Supervises the billing of claims related to government and non-government payors.
- Supervises and maintains claim gilling policies to ensure that claims are adjudicated according to program
guidelines.
- Recommends and implements procedures that will ensure the requirements of the policies are met and
sustained.
- Ensures that all claims edits, rejections, and other pre-bill work queues are worked properly according to
department and individual productivity goals.
- Maintains an effective working relationship with management and staff in other departments to include WMG,
Revenue Cycle, Coding, and Provider Enrollment.

- Keeps staff updated on guidelines and regulations related to billing and claims submission.

Identifies and creates proper education to ensure government and non-government claims are properly and accurately submitted.
- Participated in payor seminars, webinars, and educational learning programs that provide information related to
payor guidelines and CMS guidelines for claims submission.
- Works closely with the Wellstar Connect team to ensure an effective implementation of new billing systems,
identify opportunities for system or process improvements, and drive efficiencies through targeted initiatives.
- Leads and completes payor claims enrollments ensuring electronic claims submission is timely and accurate.
- Builds and creates appropriate claims holds and edits to capture specific inventory that requires review before
claim submission to the payors (i.e. master claim hold, credentialing, attachments related holds, and/or payor
specific claim holds)
- Ensures rejections, claims errors, and clearing house edits and bridges appropriately captures the correct claim
information from the facility management system.

Other Duties

- Assists in interviews and screening of job applicants, to help find for for the team.

- Develops special recognition programs and incentives for employees that is consistent and engaging.
- Ensures that all new and existing employees receive training appropriate to their job functions.
- Provides daily, weekly, and monthly reporting related to current claims inventory, outstanding issues that require
resolutions, obstacles, unresolved claims, and root cause opportunities to the Manager and Director.
- Maintains effective control systems to ensure that all work is completed in cooperation with expectations in
accordance with guidelines and policy guidelines.
- Collaborates with team to ensure a hyper focus on payers with complex billing requirements, claims with high
dollar balances, claim approaching timely filling deadlines, and other advanced billing scenarios.
- Completes month end reporting to include aging, timely filing, other claim error trending reports that impact
aging, AR, and cash payments.
- Identifies ways to reduce clearing house errors and rejections through automation, Epic hard stop and rules, and
training to key stake holders that will help reduce claims from being billed. 15%