Senior Supervisor – Operations-Denial Management
Accumed Practice Management
10.2021 - Current
- Oversaw team operations to ensure timely review, correction, and submission of medical claims, adhering to payer-mandated deadlines.
- Facilitated effective workload management to guarantee prompt claim resubmissions while adhering to established turnaround time (TAT) requirements.
- Monitored and enforced compliance with payer guidelines and regulatory standards to uphold organizational integrity in all operations.
- Executed quality assurance audits to identify process gaps and provide actionable feedback to team members.
- Supported management in process-improvement initiatives aimed at enhancing accuracy and reducing revenue leakage.
- Handled escalations by coordinating directly with payers and internal stakeholders to drive timely and effective resolution.
- Mentored and coached team members, monitored performance, and motivated the team to consistently meet KPIs and departmental goals.
- Reported team-related errors during management review meetings and facilitated corrective actions for continuous improvement.
- Collaborated with coding, data entry, and reconciliation teams to resolve discrepancies and increase claim acceptance rates.
- Reviewed claim denial reasons and guided the team with corrective measures to significantly reduce rejection rates.
- Tracked claim rejections and prepared detailed periodic reports for management, highlighting trends and areas for improvement.
- Conducted training and knowledge-sharing sessions on updated payer guidelines, workflow changes, and system enhancements.
- Partnered with IT and Cerner support teams to resolve technical issues affecting claim resubmission workflows.
- Oversaw day-to-day operations while ensuring alignment with industry regulations, quality standards, and organizational expectations.
- Directed daily operations, ensuring compliance with regulatory standards and enhancing patient care quality.