A client of Insight Global in the healthcare industry is seeking an Operations Manager for Insurance Accounts Receivable to oversee the end to tend AR process. This includes the collections, rejections, denial management, appeals and process improvements. This role will require oversight to both an onshore and offshore team and a high level of business acumen and professionalism. Key Responsibilities:
Manage Billing Operations:Oversee daily billing operations, ensuring timely and accurate processing of insurance claims and payments.
Team Leadership:Lead, mentor, and develop a team of internal and external AR analysts, providing training and performance evaluations.
Process Improvement:Identify and implement process improvements to enhance billing efficiency and accuracy.
Compliance:Ensure all billing activities comply with relevant regulations and company policies.
Reporting:Generate and analyze billing reports to monitor performance trends and identify areas for improvement.
Customer Service:Address and resolve billing inquiries and issues from clients and insurance companies.
Collaboration:Work closely with other departments, such as finance and BI, to streamline billing processes.
Key Performance Indicators (KPIs):
Collections Rate:Collection of >98% of Expected Insurance revenue of monthly released charges; also meet or exceed monthly collections goals set by Director.
AR Aging Metrics: By DOS: Maintain >90 days at less than 10% of total AR; >180+ less than 5% of AR
Denial Rate:Percentage of claims denied by insurance companies. Less than 2% of all claims.
Appeal Success Rate:Percentage of denied claims successfully appealed. 90% or greater
Timely Filing Rate: Maintain a 0% on both initial filings and appealed claims responses.
Process Improvement Metrics:Effectively incorporate billing system and clearinghouse features, AI, and other automation to workflows to drive down overhead expenses and increase revenue margins.
Offshore Team Performance:Performance metrics for offshore teams, including productivity and quality of work.
Cost Savings:Amount of cost savings achieved through FTE overhead reduction initiatives. Work closely with ESSENTIAL DUTIES AND RESPONSIBILITIES Operation Manager, Insurance Accounts Receivable 10/2024 Page 2 BI team to keep staffing at optimal levels.
Clearinghouse Rejection Rate:Percentage of claims rejected by the clearinghouse. Front-end rejections reduced to 98%.
Reporting Accuracy:Timeliness and accuracy of reporting metrics, ensuring data integrity and actionable insights.
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Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.