Claims and Remittances Supervisor

 It is our goal to provide the finest Orthopaedic care possible. This philosophy requires that all office staff and providers be sensitive and responsive to patients’ needs and preferences. To ensure that we hire and retain the quality of staff needed for implementing our philosophy of service, we have adopted the following job description for this position.

The position is a non-exempt position. Workdays are typically scheduled withing a five-day workweek. Hours and days may vary based on operational needs. All scheduling complies with applicable California wage-and-hour-laws. 

Many of the responsibilities require that you have a working knowledge of computers and the ability to make proper use of the programs utilized in this office, or those that may be necessary to meet the needs of the practice.

BASIC FUNCTION: 

Under the supervision of the Director of Revenue Cycle, the Claims and Remittances Supervisor shall provide all responsibilities necessary for the successful operation of the Arrowhead Orthopaedics business office. 

JOB SUMMARY:

The Claims and Remittances Supervisor is responsible for providing leadership oversight of all claim’s submissions, remittance processing, payment posting, and reconciliation activities to ensure accuracy, efficiency, and timely reimbursement. The duties of the Claims and Remittances Supervisor are of high volume, and the quality of duties performed need to be at a high level. The employee will come into contact daily with confidential patient and physician files. The Claims and Remittances Manager must be able to handle this information with the highest degree of privacy, discretion, and professionalism.

 Duties and Responsibilities:

• Oversee all electronic claims transmission and clearinghouse operations, ensuring claim errors and rejections are researched, resolved, and resubmitted within established service levels. 
• Serve as the primary operational resource for clearinghouse functionality, ERA/EFT processing, system-related issues, and claim transmission troubleshooting.
• Collaborate closely with the Finance Department to reconcile all incoming payments, electronic funds transfers (EFTs), remittances, and deposits while ensuring the Practice Management System accurately reflects all financial activity.
• Ensure daily, weekly, and monthly reconciliation of payment batches, bank deposits, remittance files, and practice management system balances to maintain financial integrity.
• Direct the preparation, balancing, and reconciliation of incoming payment batches while assigning workload and monitoring productivity across the payment posting team.
• Oversee the accurate posting and allocation of insurance and patient payments, including electronic remittance advice (ERA), manual explanation of benefits (EOB), and explanation of remittance (EOR) processing.
• Identify, investigate, and resolve payment posting discrepancies, reconciliation variances, and system inconsistencies in collaboration with Finance and Revenue Cycle leadership.
• Maintain the accuracy of payer fee schedules, reimbursement tables, and related system configuration within the practice management system.
• Develop, implement, and continuously improve payment posting and reconciliation workflows to enhance operational efficiency and reduce payment variance.
• Monitor departmental performance metrics, productivity, accuracy, and aging trends.
• Communicate operational updates, process improvements, and organizational changes to ensure consistency across the department.
• Partner with leadership on system implementations, upgrades, audits, and special revenue cycle initiatives.
• Perform special projects and other responsibilities, tasks, or duties as requested by the Director of Revenue Cycle. 

Supervisory Responsibilities:

• Hire, train, coach and supervise following positions in Business Office (Claims & Remittances Positions) 
• Monitor and develop employee’s performance to include, but not limited to, providing supervision, scheduling, conducting counseling and performance evaluations and delivering recognition and reward. 
• Monitoring and assessing service and satisfaction trends, evaluating and addressing issues, making improvements accordingly.
• Ensuring a high standard of appearance, patient experience, and service in employees.

  Performance Requirements:

• To perform this job successfully, an individual must be able to perform satisfactorily job duties, demonstrate excellent work habits, deliver superior service, and exhibit the highest degree of professionalism.
• Employ positive communication skills and exercise professional interpersonal abilities (tack, diplomacy, and respect) with patients and co-workers always. 
• Maintain a high degree of professionalism in the workplace, including appearance, communication, attendance, reliability, and teamwork.
• Maintain a high level of organization, including an orderly and neat work area and excellent time management skills, leading to the highest level of productivity.
• Demonstrate a desire to succeed and willingness to help others succeed. 
• Demonstrate support and comply with all Safety program elements including adherence to policies, exercise of safe work practices, participation in training, use of protective equipment, and reporting all safety concerns, hazards, and non-compliant practices.
• Serve as an employee for Arrowhead Orthaepedics, following the code of conduct, displaying the highest level of ethics and integrity in action, thoughts and conduct.

Skills and Education Requirements:

• Education: High school diploma or equivalence required.
• Bachelor’s degree in healthcare administration preferred. 
• Minimum: 2-5 years of experience in a healthcare setting. Prior management experience is a must.
• Preferred: 3 or more years in a healthcare
• Strong leadership and team supervisory skills.
• Excellent communication and customer service skills.
• Familiarity with healthcare billing and insurance processes. 
• Familiarity with Workers Comp claim structure and state fee schedule.
• Strong understanding of orthopaedic surgical coding, global surgical packages, unbundling rules and DME billing. 
• Ability to dissect complex remittance data and financial spreadsheets to find revenue leaks. 
• Excellent written and verbal communication skills to effectively convey complex contractual terms to various stakeholders. 
• Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position.

Certificates, pre-employment requirements:

• Certified Professional Coder (CPC), Certified Orthopaedic Coder (COBGC), or Certified Professional Biller (CPB) Preferred. 
• Required to submit and obtain a negative result in the pre-employment drug screening.  

Physical Demands

• Frequently standing, walking, lifting, and bending in a clinical and surgical environment.
• Ability to lift, position, or assist patients up to 50 lbs.
• Manual dexterity for procedures, suture, and equipment handling.
• Visual acuity for reviewing imaging, charts, and surgical work.

Certificates, pre-employment requirements:

• Required to submit and obtain a negative result in the pre-employment drug screening.
• Ability to pass a background check.

E-Verify Participation Notice

AO is an E-Verify employer. Candidates must be legally authorized to work in the United States. Employment eligibility will be verified in accordance with applicable federal requirements.