Manager of Enrollment and Verification

Just a few of the Benefits enjoyed by PPIL employees… -Company subsidized premiums on Medical, Dental, and Vision Insurance -Up to 12 weeks Paid Parental Leave for eligible employees -Generous Paid Time Off (PTO) and paid holidays -Mission focused work -401k with employer matching -100% company-paid Life Insurance -100% company-paid Short- and Long-Term Disability Coverage -Robust Employee Assistance Program -Professional Development awards and opportunities -Flexible Spending Accounts -Free Medical Services at PPIL -Pet Insurance The Manager of Enrollment and Verification role administers and ensures the financial compliance of the Medicaid Presumptive Eligibility and Family Planning State Screening Programs to ensure PPIL service reimbursements. The Manager of Enrollment and Verification also ensures effective financial account receivables processes through accurate patient account maintenance. This management position serves in the first entry level of the Revenue Cycle workflow that contributes to insurance verification, the prevention of insurance denials and the identification of Time of Service accounts for collections through follow up processes based on appointments and pre-Health Center service charge information. Essential Functions: 1. Effectively manages the Enrollment and Verification Team and ensures accuracy in patient account maintenance by applying consistent technical knowledge and follow up through coaching and performance oversight 2. Serves as an RCM Supervisory Liaison to work collaboratively with the Billing Vendor and Internal PPIL Payer Relations Team to resolve Insurance Denials and In/Out of Network Contract scopes through timely follow up 3. Ensures that all Assigned EPIC Workques errors are resolved daily and the validation and accuracy of the patient demographics and Insurance information for Billing 4. Ensures up to date insurance documentation is maintained in the patient accounting system to meet quality assurance, productivity and billing standards. 5. Serves as an Internal Project Manager for Revenue Cycle Audits and Training and as Subject Matter Expert (SME) for the Revenue Cycle Team regarding payer and state guidelines related to authorization and verifications 6. Provide clear and professional communication to Health Center front office and operational leadership regarding progress, feedback, and actionable next steps for any pending issues 7. Monitor performance metrics related to verifications and denials and partner collaboratively under the direction of Finance and with PPIL vendors to formulate a plan of action for improvement as necessary. 8. Escalate Payer Issues and work collaboratively with Contracts to ensure In Network/Out of Network areas are addressed and resolved and ensure that the Team follows and are aware of payer and state specific guidelines as changes are enacted 9. In collaboration with teammate RCM Managers, assist with the intake and resolution of all areas of the Revenue Cycle inbox messages for timely follow up. 10. Partner with the Health Center to ensure appropriate and accurate documentation for verifications and enrollments are completed and uploaded for Billing Vendor review and daily audit. 11. Gather and provide streamlined and consistent feedback to Health Center managers and Revenue Cycle Team regarding areas of opportunity in improving the efficiency of the verification timeline or process Other functions: 1. Address and respond to verifications and enrollments related queries from front desk teammates or the PPIL Vendors. 2. Assist as an RCM Payer Relations “problem solver” on all Front-end denials ensures follow-up 3. Accurately complete verifications for same day, scheduled appointment or walk-in patients by contacting the provided insurance via phone, fax, or online portal to obtain benefits, eligibility, and authorization information for billing accuracy 4. Ensures that accurate notes and complete follow up statuses are listed on patient accounts. 5. Ensure all authorization, verification, out of network related denials are addressed timely and accurately, providing denial prevention feedback to Health Center managers, Billing or Enrollment and Verification team as needed 6. Complete batch eligibility requests and collaborate with Health Center and RCM Team mates to ensure follow-up workflow is completed for ineligible results to ensure service reimbursement or Time of Service Collections. 7. Run EMR or BI reports daily to monitor assigned dashboard areas of focus as determined by the Director of Payer Relations. 8. Proactively Ensures Team PPFA Financial performance metrics are met 9. Proactively stay up to date on Revenue Cycle standards through self-initiated professional development to ensure accountability in performance of the duties of the role. 10. Supports and Implements the Directives of the Director of Payer Relation and Revenue Cycle Management to ensure team compliance with Department Policies and Procedures. 11. Maintain a professional and collaborative relationship with all teammates and vendors to resolve issues, increase knowledge of insurance requirements, and create standardized workflows 12. Facilitates training and onboarding of new teammates as well as ongoing training and education for established team members. 13. Accountable for Collaborating with the RCM team members who provides self-pay estimates to ensure that Insurance patients are validated and allocated to the correct patient account Financial Class prior to appointment and Billing for accuracy 14. Through these activities demonstrate an understanding of and commitment to PPIL core values of access, activism, care, confidentiality, diversity, excellence, integrity, respect, self-determination, and stewardship; practice these values in relations with internal and external customers 15. Perform other duties as assigned. Supervisor : Director of Payer Relations and Revenue Cycle Management Status : Full-time. Exempt from the overtime provisions of the wage and salary regulations. Education Associate's degree or equivalent combination of experience and education preferred. High School Diploma or GED required. Qualifications Minimum of 5 years of relevant Healthcare Professional Billing experience in a Revenue Cycle/Patient Accounts department is required. Strong knowledge of Self-Pay, Commercial, Medicaid/MCO Insurances Billing and Collections. Ability to demonstrate working knowledge of health care Billing and denials processes, including a thorough understanding of medical insurance carrier policies and procedures preferred. Ability to thoroughly demonstrate working knowledge of the Revenue Cycle workflow and error resolution of the Verification and Enrollments processes. Required technology skills must include experience in the use of spreadsheet software (Excel) and the resolution of Registration Workques in the electronic records systems (EPIC) Professional Qualities The Manager of Enrollment and Verification is a proactive problem-solver with strong analytic and interpersonal skills that possesses: • Excellent follow-through and attention to detail • Ability to lead by example and inspire others to perform at their highest level • Ability to proactively prioritize and attend to detail • Excellent interpersonal relationship management skills • Leads with Integrity and Accountability • Strong communication, written and oral, and excellent organizational skills • Ability to work under pressure and meet stringent deadlines, in a fast-paced environment with professionalism • Commitment to maintaining confidential information The Manager must demonstrate a commitment to the mission and operating goals of Planned Parenthood of Illinois $75,000 - $75,000 a year Physical Demands: The physical demand characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand, walk, talk, read, see and hear. The employee is frequently required to use hands and fingers to type, handle, or feel and reach. The employee is regularly required to sit. The employee must occasionally lift and/or move up to 25 pounds. Planned Parenthood works affirmatively to include diversity among its workforce and does not discriminate in the selection of its staff based on factors including but not limited to race, color, religion, sex, national origin, age, sexual orientation, gender identity, disability, income, marital status or any other characteristic protected under federal, state or local law. We know that BIPOC and women identifying candidates are less likely to apply to jobs unless they meet every requirement. Please do not be deterred if your past experience doesn’t align perfectly with every qualification in the job posting. We encourage you to apply anyway! You may be exactly who we are looking for! Apply for this job