Job Summary:

The intent of this job description is to provide a summary of the major duties and responsibilities performed in this job. Incumbents may be requested to perform job-related tasks other than those specifically presented in this description.

The Revenue Cycle department at RFM supports the organization’s mission of delivering exceptional patient care and creating a healthier world—one life at a time. As a high-performing, collaborative team, we prioritize quality, innovation, and continuous improvement. We seek individuals passionate about problem-solving and customer service to thrive in our dynamic environment.

The Insurance & Patient Accounts Receivable Supervisor (ARS) manages the end-to-end revenue cycle process, ensuring timely claim generation, billing, and payment resolution. This working supervisor leads a team of A/R Specialists, establishes performance metrics, and collaborates with internal and external partners to maintain efficient claims and payment processing.

Special Conditions:

• Must be able to work various hours and locations based on business needs.

Essential Job Duties: Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Revenue Cycle Management

• Oversee claim generation, billing, and final payment resolution.
• Ensure timely resolution of edits, records attachments, and open accounts receivable (A/R).

Team Leadership

• Establish departmental goals and performance metrics.
• Train, guide, and support team members to improve efficiency and ensure compliance.
• Monitor performance to achieve team objectives.

Claim and Denial Resolution

• Investigate and resolve denied claims, including filing appeals with supporting documentation.
• Follow up with payers to ensure timely payment and resolve outstanding A/R.

Insurance Verification

• Verify patient coverage and adjudicate claims accurately via payer portals, phone, or the Epic system.
• Prioritize workloads based on payer-specific policies and deadlines.

Compliance and Regulation

• Adhere to HIPAA, PHI, CMS regulations, and state/federal revenue cycle standards.
• Develop and enforce policies to maintain compliance.

Technical Expertise

• Apply knowledge of CPT, HCPCS, ICD-10 codes, and modifiers to ensure accurate claims processing.
• Utilize Epic and payer system logic to optimize billing efficiency.

Collaboration and Communication

• Coordinate with internal departments and external partners to ensure efficient claim resolution.
• Maintain professional communication with payers to address discrepancies and secure payments.

Financial Reconciliation

• Process cash postings, refunds, and account adjustments.
• Analyze EOBs, payer payments, and allowable amounts for accurate account reconciliation.

Customer Service

• Address patient account inquiries with professionalism and a customer-focused approach.
• Ensure clear communication with patients, team members, and external partners.

Reporting and Improvement

• Monitor and report on key performance metrics.
• Identify and implement process improvements to enhance efficiency and accuracy.

Administrative Duties

• Utilize MS Office products and Epic systems to perform daily tasks.
• Organize and maintain documentation for billing, appeals, and A/R activities.

Required education and experience: The requirements listed below are representative of the knowledge, skills, and/or ability required.

Minimum Education required:

• High school diploma or equivalent (required).
• Associate’s degree or relevant coursework preferred.
• Billing or Coding Certificate or equivalent experience.

Minimum Experience Required:

• At least three (3) yrs. experience in billing, denials mitigation.

• At least 1 year in a managerial/supervisory role.

• At least three (3) years of experience in medical claims billing, denial mitigation, and appeals in an automated environment.

• Epic EMR experience (Resolute Professional Billing) with claim logic knowledge is preferred.

• Familiarity with medical terminology, coding principles, and payer systems.

Minimum Knowledge and Skills Required:

• Expertise in medical insurance, CMS regulations, and billing processes.
• Proficiency in CPT, HCPCS, ICD-10 codes, and accounting principles (e.g., cash postings, debits/credits).
• Strong written/verbal communication, organizational, and problem-solving skills.
• Detail-oriented, self-motivated, and capable of working both independently and collaboratively.
• Mid-level proficiency with MS Office (Mail, Excel, Word).