Billing & Collections Supervisor

Job Description

Job Description

Job Summary:

The Billing & Collections Supervisor is responsible for overseeing the daily operations of the pharmacy billing department, ensuring timely and accurate billing, claim submission, reimbursement, payment posting, and resolution of billing issues. This position leads a team of billing specialists and works collaboratively with reimbursement, pharmacy operations, finance, patient services, manufacturers, and payers to maximize revenue while maintaining compliance with federal, state, payer, and accreditation requirements.

The Billing & Collections Supervisor monitors productivity, quality, and key performance indicators while driving continuous process improvement and exceptional customer service.

The below is intended to describe the general content of and requirements for the performance of this job and is not to be construed as an exhaustive statement of essential functions, responsibilities, or requirements.

Primary Duties and Responsibilities

1. Leadership
   1. Supervise, coach, develop, and evaluate Billing Specialists.
   2. Establish departmental goals and performance expectations.
   3. Conduct regular one-on-one meetings and annual performance evaluations.
   4. Develop staff training programs and cross-training initiatives.
   5. Monitor staffing levels and workload distribution.
2. Billing/Collections Operations
   1. Oversee daily billing activities for commercial, Medicare, Medicaid, and government payers.
   2. Ensure timely and accurate submission of pharmacy claims.
   3. Monitor electronic claim acceptance, denials, and rejections.
   4. Review high-dollar claims and complex billing issues.
   5. Ensure accurate payment posting and account reconciliation.
   6. Coordinate secondary billing and coordination of benefits.
   7. Oversee credit balances, refunds, and adjustments.
   8. Supervise the daily collection activities for outstanding accounts receivable, ensuring timely follow-up on unpaid claims and patient balances.
   9. Oversee work queues for commercial, Medicare, Medicaid, manufacturer assistance programs, and third-party payers.
   10. Develop and monitor collection strategies to improve cash flow and reduce aged accounts receivable.
   11. Ensure timely resolution of underpayments, denied claims, and outstanding balances through appeals, payer follow-up, and account research.
   12. Review and approve account adjustments, write-offs, refunds, and payment plans in accordance with company policies.
   13. Monitor payer trends and identify recurring reimbursement issues impacting collections.
   14. Collaborate with Reimbursement Specialists, Prior Authorization, Patient Financial Services, and Finance to resolve complex billing and collection issues.
   15. Establish collection priorities based on aging, payer requirements, and financial impact.

1. Prepare and present monthly collection reports, aging analyses, and cash collection forecasts to leadership.
2. Ensure compliance with all federal and state regulations related to collections, patient billing, and reimbursement practices.

1. Revenue Cycle Management
   1. Monitor accounts receivable aging.
   2. Reduce outstanding receivables through proactive follow-up.
   3. Identify reimbursement trends and opportunities for improvement.
   4. Analyze billing errors and implement corrective actions.
   5. Ensure clean claim rates meet organizational goals.
2. Denials Management
   1. Supervise denial resolution processes.
   2. Identify root causes of denials.
   3. Develop action plans to reduce recurring denials.
   4. Escalate payer issues when appropriate.
   5. Partner with reimbursement specialists to improve collections.
3. Compliance
   1. Ensure compliance with:
   2. HIPAA
   3. Medicare and Medicaid billing regulations
   4. Commercial payer requirements
   5. CMS guidelines
   6. Specialty pharmacy accreditation standards (URAC and ACHC)
   7. Company policies and procedures
4. Quality Improvement
   1. Monitor billing accuracy and productivity metrics.
   2. Perform quality audits.
   3. Develop process improvements to increase efficiency.
   4. Assist with system upgrades and workflow enhancements.
   5. Participate in internal and external audits.

1. Cross-Functional Collaboration
   1. Partner with:
      1. Pharmacy Operations
      2. Finance
      3. Reimbursement
      4. Patient Care
      5. Prior Authorization
      6. Client Services
      7. Information Technology
      8. Resolve complex billing issues affecting patient care and reimbursement.
2. Reporting
   1. Prepare and analyze reports including:
   2. Claims submission volumes
   3. Denial rates
   4. Collection percentages
   5. Accounts receivable aging
   6. Billing productivity
   7. Revenue trends
   8. Staff performance metrics
   9. KPI dashboards
3. Regular and reliable attendance is expected.
4. Other work-related duties as assigned by supervisor/manager.

Minimum Knowledge, Abilities, and Skills Required

• Bachelor's degree in Business, or related field

• 5+ years of pharmacy, medical billing, or revenue cycle experience.
• 2+ years of supervisory or team leadership experience.
• Specialty pharmacy billing experience strongly preferred.