Major Responsibilities:

Responsible for supervising department functions and provide leadership to the Insurance Refunds Teams. Responsible for ensuring prompt and accurate responses to refund requests from insurance companies, agencies, third party vendors and/or patients. Responsible for ensuring prompt and accurate processing of all refund requests. Ensure that proper internal controls are established and followed related to credit balances and refund transaction processing.Ensures that credit balances are identified, properly researched, documented, and scheduled to be refunded to the appropriate party. Ensures that all credit balances are resolved in a timely manner. This includes having in depth knowledge of Managed Care contract terms and Medicare and Medicaid Reimbursement methodologyResponsible for ensuring segregation of duties, maintaining an effective control environment to ensure refund functions are in compliance with internal policies and procedures and external Federal, State and contracted payer regulations. Monitor procedures to ensure that any refund check returned is appropriately transferred to the unclaimed property account.Proactively review and analyze credit balances to determine the root cause generating the credit balance. Responsible for ensuring the review and completion of all credit balances.Ensures the resolution of patient and insurance credits as they related to correct assignment of account number and issue refunds in a timely manner to ensure continued patient satisfaction. Responsible for assuring accurate record retention of refund documentation for audit purposes.Responsible for organizing, planning and guiding the credit resolution environments (including across multiple systems) that promote professional growth and development, and assures customer service excellence. Participate in maintaining an effective internal control environment that ensures compliance with all internal policies and operating procedures, external federal and state regulations, and the safeguarding of Advocate Aurora Health Care assets. Participates in and supports overall credit resolution surrounding the development and integration of new and innovative approaches to using people, processes, contracts and technology to decrease credit volumes.Assists in the development and implementation long and short-range goals, objectives, tactics, and policies/procedures that interface with other functional areas to improve operations. Review and maintain accountability around departmental productivity and quality levels. Collaborates with manager to analyze statistical information, leading indicators and operating metrics; contributes to development of plans in response to data; establish goals, standard and target time frames for initiative implementation and completion. This includes using industry “Best Practices” and “Key Performance Indicators” (KPI’s) to set objectives and measurable goals. Supervise areas of responsibility to meet the committed goals. Partner with revenue cycle leaders, payers, contracting and managed care teams to address root cause of insurance reimbursement trend issues. Oversees projects and work books resulting from managed care, auditing, third party vendors or compliance.Accountable for meeting the staffing needs of the department and contributes to development, reviews and monitor financial and performance outcomes to achieve organizational goals and objectives. Participates in setting vision for service excellence and promoting a work culture of excellence. Establish team performance standards and goals that drive improved overposted and undistributed credit volumes, benefit from revenue cycle operations, initiates action plans, monitors performance to standards, provides feedback, identifies supportive resources and provides redirection if necessary.Collaborates with manager to determine team structure and implement staffing models based on operational and statistical information. Utilizes staffing analysis to ensure appropriate staffing coverage based on account volumes. Assures appropriate allocation of resources based on business needs and service levels. Reviews and approves time and attendance for payroll. Monitors all scheduled and unscheduled paid time off. Assists in the development of job descriptions, interviews and hires team members with the support of human resources. Appropriately utilizes performance recognition, promotional, disciplinary and salary management pathways as established by Advocate Aurora Health to recognize, award and incent individual team member performance. Provide leadership and direction through training, mentoring/coaching, performance evaluations and employee conferences. Provide development and enrichment opportunities for associates. Serves as a resource to associates for questions/issues.Performs human resources responsibilities for staff which includes coaching on performance, completes performance reviews and overall staff morale. Recommends hiring, compensation changes, promotions, corrective action decisions, and terminations.Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.

Licensure, Registration, and/or Certification Required:

None Required.

Education Required:

High School Graduate.

Experience Required:

Typically requires 3 years of experience in Cash Management or Accounting functions or Healthcare Billing within a healthcare delivery system.

Knowledge, Skills & Abilities Required:

Excellent supervisory and leadership skills.Excellent communication, organizational and customer service skills.Ability to oversee multiple projects simultaneously with knowledge of all aspects of the hospital billing and physician billing.Demonstrate high performance of supervisor skills including ability to work well with others, team building skills, organizational, communication and presentation skills.Experience with patient account reconciliation, credit balance resolution and refunds preferred.Ability to work collaboratively across disciplines.Excellent process redesign skills.Ability to interpret and understand a Managed Care Contract, supporting system, reimbursement and government regulations, and reimbursement models in effect.Strong knowledge of PCI compliance and how it pertains to the Healthcare environment.Demonstrate the ability to react quickly to an ever changing environment.Exhibit proficiency and knowledge of health care revenue cycle processes as well as accounting practices.

Physical Requirements and Working Conditions:

Operates all equipment necessary to perform the job.Exposed to normal office environment.Exposed to road, weather and normal travel hazards.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.