Pinnacle Healthcare Consulting

Manager

• Oversee all eligibility verification and authorization procurement activities for all service lines
• Responsible for the team’s production and the completion of designated KPIs
• Manage the R/E process to ensure that the avoidable denial percentages are within acceptable ranges
• Review and interpret monthly denial reports to identify areas of opportunity
• Monitor staff for compliance of the organization’s confidentiality policy in accordance with the Health Insurance Portability and Accountability Act (HIPAA) regulations
• Seek opportunities for automation and/or disruption in the traditional methods to reduce denials
• Ensure staff production, quality and compliance is maintained to company standards by assigning tasks to staff and monitoring to ensure performance
• Identify and resolve problems and inconsistencies
• Identify opportunities to build process and communication workflows with practice staff and/or management
• Assist Revenue Optimization Specialist (ROS) for R/E in staying current on all payer bulletins and communicate pertinent information to staff
• Work with ROS to design, implement or evaluate staff training and performance measurement criteria
• Recruit, interview and select new employees with assistance from human resources
• Responsible for supervising assigned staff, including attendance, paid time off, payroll, training, corrective action and performance evaluations
• Develop work schedules according to budgets and workloads
• Complete all tasks assigned by the Director in a timely manner

RCM Referral & Eligibility Manager

Accounts Receivable

• Support the PHRS mission, vision, core values and customer service philosophy.
• Interact with physicians, patients, and insurance vendors to investigate outstanding claims and incomplete payments.
• Provide first level customer support for billing services.
• Complete patient billing and investigate daily denials by working with insurance vendors to resolve problem accounts.
• Develop and maintain effective relationships through effective and timely communication.
• Ensure compliance with all state and federal billing regulations, including HIPAA.

RCM Referral & Eligibility Manager

Accounts Receivable Specialist