- Researches complex bill review data to identify trends and implement best practices by running and analyzing reports ; determining root causes of increased charges or payment allowances; determining solutions to negative trends; maximizing benefits of positive trends (for example, applying cost savings across multiple states); evaluating performance metrics (for example, reconsideration logs, savings dashboard); partnering with other teams (for example, analytics, senior coordinators, case managers, dental providers, defense counsel, regulatory agencies); and developing and maintaining workflow processes to ensure accurate implementation.
- Ensures compliance with laws and regulations by researching changes to federal, state, and local laws and regulations impacting insurance payment of dental bills; ensuring changes in state reporting requirements, periodic fee schedules, and applicable laws and regulations are applied to bill review process and procedures; evaluating auditing results to ensure the audit forms measure the desired quality results ; modifying the auditing process as regulatory agency requirements change; building and maintaining relationships with other bill processing teams, state agencies, the Legal department, and bill review suppliers to clarify regulations or implement systematic changes required for compliance; evaluating vendor processors quality audit results, providing feedback on results to vendor processors, and creating action plans to correct deficiencies; and ensuring regulatory certifications for state and federal utilization and bill review are obtained.
- Serves as subject matter expert by educating internal teams about bill review process and system changes; providing supporting information and education related to litigation of bill review to defense counsel; analyzing bill review litigation trends with adjusting teams and Legal department to develop solutions for implementation; collaborating with third party administrators to improve processes ; drafting letters and developing explanation of review statements for multiple states; educating team and vendor processors on pre-litigation best practices; and participating and leading special projects to enhance bill payment processes.
- Manages customer service and vendor call centers by reviewing reports on call time averages to make sure calls are processed efficiently and effectively; ensuring responses to inquiries regarding dental billing from internal and external stakeholders ; and identifying and resolving global trends on escalated issues (for example, unprocessed hospital bill complaints).
- Coordinates, completes, and oversees job-related activities and assignments by developing and maintaining relationships with key stakeholders; supporting plans and initiatives to meet customer and business needs; identifying and communicating goals and objectives; building accountability for and measuring progress in achieving results; identifying and addressing improvement opportunities; and demonstrating adaptability and promoting continuous learning.
- Provides supervision and development opportunities for associates by hiring and training; mentoring; assigning duties; providing recognition; and ensuring diversity awareness.
- Ensures compliance with company policies and procedures and supports company mission, values, and standards of ethics and integrity by implementing related action plans; utilizing and supporting the Open Door Policy; and providing direction and guidance on applying these in executing business processes and practices.
- Required: Three (3) years of previous dental insurance billing and follow-up experience
- Excellent communication skills
- Able to understand CDT codes and EOBs for dental insurance.
- Ability to be proactive and take initiative.
- Models the Walmart values to foster our culture; holds oneself and others accountable; and supports Walmart's commitment to communities, social justice, corporate social responsibility, and sustainability; maintains and promotes the highest standards of integrity, ethics and compliance.
- Acts as an altruistic servant leader and is consistently humble, self-aware, honest, and transparent.
- Demonstrates curiosity and a growth mindset; fosters an environment that supports learning, innovation, and intelligent risk-taking; and exhibits resilience in the face of setbacks.
- Seeks and implements continuous improvements and encourages the team to leverage new digital tools and ways of working.
- Delivers expected business results while putting the customer first and consistently applying an omni-merchant mindset and the EDLP and EDLC business models to all plans.
- Adopts a holistic perspective that considers data, analytics, customer insights, and different parts of the business when making plans and shaping the team's strategy.
- Identifies, attracts, and retains diverse and inclusive team members; builds a high-performing team; embraces diversity in all its forms; and actively supports diversity goal programs.
- Builds strong and trusting relationships with team members and business partners; works collaboratively and cross-functionally to achieve objectives; and communicates with energy and positivity to motivate, influence, and inspire commitment and action.
- Creates a discipline and focus around developing talent, promotes an environment allowing everyone to bring their best selves to work, empowers associates and partners to act in the best interest of the customer and company, and regularly recognizes others' contributions and accomplishments.
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Manager, Billing - Bentonville, United States - Wal-Mart
Description
Position Summary...What you'll do...
The ideal candidate will focus on commitment to quality, as well as adhere to the company's team members through the management of Walmart Health and Wellness Revenue Cycle Operations.
What you'll do...
It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.
The full Job Description can be made available as part of the hiring process.Basic Qualifications
Epic EMR experience, third party offshore vendor management, process management for insurance benefit verification, ability to track and resolve billing discrepancies based on denials and experience in collaborating and communication with RCM department heads regarding billing issues to ensure a streamlined and efficient workflow with the RCM Team.
Live our Values
Culture Champion
Curiosity & Courage
Customer Focus
Diversity, Equity & Inclusion
Outlined below are the required minimum qualifications for this position. If none are listed, there are no minimum qualifications.
Minimum Qualifications:
Bachelor's degree in Business Management, Accounting, Project Management, Healthcare Management, or related field and 1 year's experience in insurance claims, accounting, or related area OR 3 years' experience in insurance claims, accounting, or related area.
Preferred Qualifications...Outlined below are the optional preferred qualifications for this position. If none are listed, there are no preferred qualifications.
Masters:
Business Administration
Primary Location...
2608 Se J St, BENTONVILLE, AR 72712, United States of America
