Credit and Refund Operations Supervisor

CHI Memorial Mountain Management Services

CHI Memorial Medical Group (Mountain Management Services) now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health is a Management Service Organization (MSO) that provides comprehensive office management services for all Memorial Health Partners and many physicians in private practice. We are proud to be a part of the regional referral center of choice providing health care throughout Southeast Tennessee and North Georgia.

We care about our employees well-being and offer benefits that complement work/life balance.

We offer the following benefits to support you and your family:

Free Membership to our program supporting any child care pet care or adult dependent needs

Employee Assistance Program (EAP) for you and your family

Health/Dental/Vision Insurance

Flexible spending accounts

Voluntary Protection: Group Accident Critical Illness and Identity Theft

Adoption Assistance

Paid Time Off (PTO)

Tuition Assistance for career growth and development

Matching Retirement Programs

Wellness Program

If you are passionate about the patient experience and ready to join our nationally recognized hospital connect with us today!

Job Summary / Purpose
Under general supervision the Supervisor-Credit Balance Refunds is responsible for planning supervising and evaluating the daily operations of the assigned business office/revenue cycle function(s) in accordance with established business objectives and applicable regulatory requirements. The Supervisor continuously monitors work queue volumes and productivity as well as the accuracy and timeliness of work results to ensure compliance with internal policies/procedures and customer satisfaction standards. Work includes responsibility for the timely and accurate resolution of all credit balance accounts and any action on accounts that result in unapplied activity.

1. Schedules supervises and evaluates the work of assigned revenue cycle staff in accordance with established standards and procedures; assists in identifying adequate staffing levels for appropriate coverage to meet budgetary and operational objectives.

• Implements and enforces quality control/quality assurance and productivity standards; ensures that applicable standards systems and procedures are understood and followed; monitors and audits related documentation to ensure conformance with established standards relating to timeliness and accuracy; prepares periodic productivity reports and program updates for review of higher-level authority.
• Researches inquiries complaints and requests by internal/external customers and takes appropriate steps to resolve errors or issues; communicates resolution to all interested parties.
• Participates in the development of and implements new/revised guidelines procedures processes and/or training materials in support of assigned function/work unit to facilitate regulatory compliance and maximize revenues; ensures that employees understand and apply internal guidelines appropriately.
• Reviews and approves within dollar limits as defined by policy all refund requests and other revenue cycle actions that are outside the parameters of standard procedures.
• Prepares weekly refunds balancing logs for various markets to ensure accuracy of information and adequate balancing reconciliation with various markets
• Receives all refund checks and ensures proper quantity and information accuracy is maintained
• Prepares refund checks for mailing by utilizing folding machine and postage machine

1. Schedules supervises and evaluates the work of assigned revenue cycle staff in accordance with established standards and procedures; assists in identifying adequate staffing levels for appropriate coverage to meet budgetary and operational objectives.

• Interviews job candidates and makes employment and other staff-related recommendations; ensures that staff are qualified and properly trained to perform assigned job duties.
• Orients/trains employees and holds regular staff meetings to keep employees appraised of all matters relevant to successful job performance; approves timecards and time off requests.
• Communicates performance standards and evaluates employee performance; counsels employees providing constructive feedback and recognizing results achieved; participates in performance management activities as required.
• Addresses and resolves technical issues referred by subordinates as beyond their scope of authority.
• Anticipates potential areas of concern within the credit balance and refund functions; identify issues/trends and conducts staff training to address and rectify.
• Recognizes when additional assistance is needed to resolve credit balances and escalates appropriately and timely through defined communication and escalation channels.
• Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies procedures and other job aides.

1. Monitors and assesses current operations/services to identify performance/process improvement opportunities.

• Provides recommendations to the Manager for performance/process improvements initiatives; implements approved changes and ensures that staff receive the necessary on-the-job training to enhance their understanding of performance improvement initiatives.
• Monitors staff errors and overall productivity identifies trends and retrains as necessary to improve performance/results.
• Participates in revenue cycle/business planning activities including the development/implementation of work unit objectives/projects to address current and future needs to support achievement of business objectives.

1. Establishes and maintains professional and effective relationships with peers and other stakeholders; serves as liaison with various internal departments/staff/providers in coordinating and troubleshooting various revenue cycle-related issues.

• Establishes and maintains a professional relationship with markets in order to resolve issues.
• Promotes an atmosphere of collaboration so all parties feel comfortable approaching with issues and challenges specific to their market

• Reviews accounts and/or reports including: Explanation of Benefits (EOB)/ Electronic Remittance Advice (ERAs) payments adjustments insurance contracts and contracting system insurance benefits and all account comments; contacts and communicates with insurance companies to gather additional information as necessary.
• Refunds overpayments on accounts and transfers payments to the appropriate accounts.
• Verifies all patient account charges are billed to the insurance plan.
• Validates that insurance has paid correctly and identifies any patient responsibility.
• Conducts appropriate review to accurately transfer payments in accordance with established procedures.

1. Utilizes available resources to review payment discrepancies and identify trends/reasons for future discussion.

• Proactively identifies researches and resolves (with position scope) unusual complex or escalated issues as necessary.
• Notifies Supervisor/Manager of ongoing issues and concerns.

1. Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.

• Adheres to refund approval protocols for non-routine refunds.
• Meets quality assurance and productivity standards through identification reconciliation of credit balance accounts and review of credit balance reports for potential overpayments in accordance with organizational policies and procedures.

1. Maintains current knowledge of internal industry and government regulations as applicable to assigned function.

• Applies knowledge of detailed billing requirements and insurance follow-up practices.
• Has knowledge of and is compliant with government regulations including signature on file requirements compliance program HIPAA etc.

1. Establishes and maintains professional and effective relationships with peers payers and patients.

• Establishes and maintains a professional relationship with payers and FMG staff in order to resolve issues.
• Depending on role and Epic training may be called upon to support other areas in the Revenue Cycle.

1. Work requires proactive troubleshooting significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies and bring timely resolution to issues that have a potential impact on revenues.

• Serves as a resource for staff and assists the Manager through the transmission of work instructions and participation in the planning development and implementation of new/revised procedures.

Required Education:
High School Diploma or GED equivalent

PREFERRED Qualifications:
Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities.

Graduation from a post-high school program in medical billing or other business-related field is preferred.